Abstract

Chronic dacryocystitis is an inflammatory process of the lacrimal sac associated with total or partial occlusion of the Nasolacrimal duct and is the most common cause of ocular morbidity accounting for 87.1% of epihora. Dacryocystitis is having a higher incidence among lower socioeconomic status and causes ocular morbidity. Ever since the description of this procedure by Toti in 1905, External dacryocystorhinostomy (DCR) became the gold standard and economical surgical procedure with excellent results compared to other surgical procedures. Whether to do a single flap or double flap technique during external DCR for chronic dacryocystitis depended
on patho-anatomy and the surgeon preferences aiming the best outcome. There is a limited number of studies on this clinical problem in Andhra Pradesh and other states of India in Government institutions. Ambiguity still remains, regarding repair of anterior flap alone or double flap technique of external DCR. In view of that, we have taken up the studies at a tertiary eye care center in Andhra Pradesh. Aims: To assess and compare the outcome of the single flap and double flap techniques of External Dacrocystorhinostomy (DCR) in chronic dacryocystitis.
Settings and Design: A prospective interventional study has been done at the Department of Ophthalmology Sri Ram Narayan Ruia Government General Hospital (SVRRGGH) attached to Sri Venkateswara Medical College (SVMC), Tirupati between October 2015 and October 2018 to evaluate the results of external DCR for chronic dacryocystitis. A comparative study between two methods of performing external DCR is also included in this study, i.e. single flap technique and double flap technique. The outcome is considered as surgical success when there is anatomical and functional patency of the lacrimal drainage system until the end of the follow-up period, i.e. six months. The study was approved by the ethics committee of the Institution. Methods and material: A prospective randomized interventional study conducted. A total of 50 cases with chronic dacryocystitis were undergone. External DCR in this study, fulfilling the inclusion criteria. Patients who underwent single flap surgery were placed in Group A, and those with double flap in Group B and results were analyzed. Statistical analysis used: SPSS 13. Results: A total of 50 cases of
External DCR were performed in this study. Patients who underwent single flap surgery were placed in Group A, and those with double flap in Group B Age of patients was in the range of 21–70 years with a mean age of 43.15 years and 43.13 years respectively with a female preponderance. Anatomical patency is tested by syringing. Functional
patency is assessed by Munk’s score. As per the criteria of surgical success, 24 operations in Group ‘A’ which were done by a single flap technique, were successful with a success rate of 96%. And in ‘B’, the double flap surgery group all 25 operations were successful, giving a 100% success rate. Bleeding of more than usually expected occurred in 6 patients during surgery. Peri-orbital ecchymosis was seen in 5 patients in total, 2 in single flap and 3 in the double flap. Epistaxis observed in one case each in group A and B. Conclusions: Our study compared single flap vs double flap surgery in external DCR among patients with chronic dacryocystitis. Both single flap and double flap techniques
of External DCR are effective methods of treating epiphora due to chronic dacryocystitis. The single flap technique is easier to perform and resulted in functional outcome. There is no statistical significance between surgical outcomes of the single flap and double flap techniques of external DCR. The double flap technique showed a higher success
rate. Results of both single flap technique and double flap technique in this study are comparable with other studies.
Keywords: Dacryocystitis; Dacryocystorhinostomy (DCR); Munk’s Score; Nasolacrimal duct obstruction
(NLDO); Fluoresceine dye disappearance test (FDDT).

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