Presentation on theme: "DACRYOCYSTORHINOSTOMY EXTERNAL VS ENDOCANALICULAR DCR (ECL-DCR)"— Presentation transcript:
1DACRYOCYSTORHINOSTOMY EXTERNAL VS ENDOCANALICULAR DCR (ECL-DCR)
2IntroductionEpiphora is a relatively frequent problem in ophthalmology .Standard surgery is Dacryocystorhinostomy.Recent advent of laser technology.
3Inclusion CriteriaPrimary acquired nasolacrimal duct obstruction with / without chronic dacryocystitisPatent canaliculiNormal eyelid functionPatients age less than 40 years
4Exclusion Criteria Sac pathology History of previous sac surgery Lacrimal fistulaTurbinate hypertrophyGross deviated nasal septumNasal Pathology(Atrophic Rhinitis,Polyp)
5Pre-Operative Evaluation HistoryClinical evaluationExamination of lidsAssessment of punctumExamination of sac areaNasal examinationDiagnostic TestsFlourescein Dye Disappearance TestLacrimal syringing
6Follow up At 10th day, one and six months post surgery Results were graded as :Full Success – NO TEARSNO INFECTIONNO REFLUXPartial Success - LESS TEARING THAN BEFOREPARTIAL REFLUXSurgical Failure PERSISTENT TEARINGCLOSED OSTIUM
7Steps Of External DCR 1. Skin incision 2. Bone osteotomy 3. Dissection of sac flap4. Anastomosis of flap
9Procedure for ECL-DCRAnesthetise the nasal cavity with 10% Xylocaine sprayDilate the punctumProbing.Feel the bone.Wavelength980nmOptical power10 WattAiming Beam635nm, 4mW; brightness adjustableOperating Modecw, pulsedDimensions (H x W x D)12 X 26 X 30Weight5Kg
10Procedure Keep the initial power at 7 watt. Insert the 600µ fiber into the cannaliculus upto the lacrimal bone.Focus endoscope in a way that the middle turbinate remains in central vision when the red aiming beam is seen above or in front of the anterior end of middle turbinatePress the laser footswitch maintaining moderate pressure against bone with the DCR cannula.
11Procedure Fire the laser. On any resistance from the bone or sac, increase the power.Manipulate the cannula and keep firing the laser to increase the size of the opening (4-5mm).Syringing at the end of the surgery with normal saline water, then with dilute povidone iodine solution or Betadine,