|Year : 1983 | Volume
| Issue : 4 | Page : 323
D.C.R.-a modified technique
Ophthalmic Surgeon, 1678 E, Rajarampuri, Kolhapur, India
A M Joglekar
Ophthalmic Surgeon, 1678 E, Rajarampuri, Kolhapur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Joglekar A M. D.C.R.-a modified technique. Indian J Ophthalmol 1983;31:323
Dacryocystorhinostomy by routine method gives definitly few failures in the best hands where all technical details are observed like proper size of bony window (12.5 mm x 10 mm). proper suturing and proper size of flaps, The avearge rate of success is about 90%, ranging from 80 0 '0 to 95.7%.
In failed cases, when the site is explored, one can observe growth of granulation tissue in raw areas. In routine method, only two areas of the stoma are covered by mucosa and superior and inferior areas are left raw.
The intent of this paper is to describe a surgical technique which will take care of all areas of stoma with mucosa.
| Materials and methods|| |
Formation of Mucosal Flaps and Suturing
Under local anaesthesia with xylocaine 2'/0' with adrenaline and surface anaesthesia for nasal cavity, lacrymal sac is exposed. Bony window is formed taking care of nasal mucosa. Bony window is kept about 15 mm x 10 mm.
As usual medical wall of the lacrymal sac is divided into anterior and posterior panels. Nasal mucosa is divided into superior and inferior panels by `I' shaped incision instead of `H' shaped incision
Supeior and inferior panels made up of nasal mucosa are sutured with the periostium of bony window.
At this stage a small polythene tube is introduced through the respective nostril and placed over the posterior panel of lacrimal sac. Thus we are keeping posterior panel of the lacrimal sac, in proper position, with help of the polythene tube. The other end of the small polythene tube is secured in position by adhesives on cheek.
Anterior panel of the lacrymal sac is finally sutured with the periostium. The skin is sutured as usual.
All mucosal suturing is done with 8-0 black silk with cleft palate needle,
| POST-OPERATIVE TREATMENTS|| |
Skin sutures are removed on 6th day of operation. Sac syringing is done, once only, on the same day. Nasal decongestant and Antibiotic Eye drops are used for two weeks.
| Observations|| |
Follow up ranges from 6 months to two years. Total 86 cases were included in the series. Four case had recurrence of symptoms (95.34% success).
Previously with routine methods, success rate was about 80% only, in the same hands.
| Summary|| |
Modified-technique for dacryocystorhinostomy operation is described. In our experince chances of blocking of stoma with granulation tissue are reduced with this modification.