Efficacy and Safety of Modified Seamless Endoscopic Dacryocystorhinostomy in Patients with Chronic Dacryocystitis

Abstract

Objective. To evaluate the efficacy and safety of a modified seamless endoscopic dacryocystorhinostomy (EN-DCR) with chronic dacryocystitis. Methods. This study included 54 patients (54 eyes) with chronic dacryocystitis treated in our hospital from 2019 to 2021, including 32 patients (32 eyes) who underwent modified and 22 patients (22 eyes) who underwent routine EN-DCR. In the modified EN-DCR, the nasal cavity was filled 30 min before the operation by injection of 1 mg/ml adrenaline hydrochloride and application of ephedrine hydrochloride and nitrofurazone nasal drops. Before the operation, the lacrimal passages were rinsed with a 1 : 2 mixture of dilute methylene blue and normal saline. The “I”-shaped incision was replaced by a “C“-shaped incision near the lateral bone window. In place of suturing, a gelatin sponge was applied at the confluence of the lacrimal sac and nasal mucosa. After the end of the operation, the lacrimal sac was filled with tapered expansion sponge for 1 week. In routine EN-DCR, the nasal cavity was filled with 1 mg/ml epinephrine hydrochloride, and nitrofurazone nasal drops were provided for 5 minutes after the beginning of the operation; and a “I”-shaped incision was made in the nasal mucosa, with one stitch for each anterior and posterior flap. Operation time, intraoperative bleeding, and postoperative lacrimal duct irrigation were compared, with the curative effect evaluated after a follow-up of 6 months. Results. Operation time was significantly shorter (41.3 ± 12.1 min vs. 65.4 ± 11.6 min; χ2 = 7.312, $P<0.05$ ) and intraoperative bleeding was significantly lower (12.5 ± 5.2 ml vs. 60.3 ± 8.9 ml; χ2 = 24.883, $P<0.05$ ) in the modified group than in the routine EN-DCR group. After follow-up for 6 months, the effective cure rate was significantly higher in the modified group than in the routine group (96.9% vs. 68.2%; χ2 = 6.383, $P<0.05$ ). Conclusion. Compared with routine EN-DCR, modified seamless EN-DCR can achieve better surgical outcomes, shorten operation time, and reduce intraoperative bleeding.