ENDOSCOPIC DACRYOCYSTORHINOSTOMY [DCR] WITH MEROCEL PACK IN THE LACRIMAL SAC- AN INNOVATIVE TECHNIQUE

BACKGROUND DCR is a surgical procedure performed to create a new tear drainage pathway between the eye and the nose when the tear drain becomes obstructed at the level of nasolacrimal duct, which is the commonest site of blockage in lacrimal apparatus. This technique of DCR with Merocel pack in the lacrimal sac completely avoids any complications like lacrimal pump failure, canthal erosion, canthal cheese wiring, although few patients exhibit complications like granuloma, synechiae/adhesions and foreign body sensation inside the nose for few days. Patients are relieved of epiphora/mucocele with less operative time and post-operative care. The objective of the study is to describe the various complications, which can occur in endoscopic DCR procedure. MATERIALS AND METHODS It is a descriptive study. We enrolled 30 participants with nasolacrimal duct obstruction presenting with epiphora, mucocele and palpable lacrimal sac and were managed with endoscopic DCR with a 'Merocel pack in the sac technique.' The present study was conducted at the Ministry of Health Hospital, Rustaq, Sultanate of Oman, during 2007 to 2014. The sample size was taken for convenience during the study. RESULTS Results were compared with standard external DCR and endoscopic DCR with silicone stents. All patients were operated under general anaesthesia. Participants were followed for 6 months and outcomes (Absence of epiphora and the patency of sac) and complications (lacrimal pump failure, canthal erosion, canthal cheese wiring granuloma, synechiae/adhesion and foreign body sensation) were measured. Lacrimal sac was opened and the Merocel pack was kept in the sac (1 cm x 0.5 cm) for 10 days and then removed. The present innovative technique gave good results (p-value < 0.0001), took less post-operative time and fewer postoperative complications. CONCLUSION Endoscopic DCR with 'Merocel pack in the sac technique' is an excellent novel technique for the treatment of epiphora and mucocele due to nasolacrimal duct obstruction. It should be the treatment of choice in view of maintenance of long-term results, patient compliance and cost effectiveness.