Authors: Vinay Kansal, Ali Jamal, Rick Jaggi

Author Disclosure Block: V. Kansal: None. A. Jamal: None. R. Jaggi: None.

Abstract Body:

Purpose: Endoscopic, endonasal approach for dacrocystorhinostomy (DCR) is a popular approach in the treatment of chronic epiphora. Preservation of a nasal mucosal flap may reduce success rates. This study records outcomes of nasal mucosa preserving versus non-preserving techniques.
Study Design: Retrospective consecutive chart review
Methods: Retrospective chart review of sequential endonasal DCRs performed by a single surgeon in the Saskatoon Health Region between April 2014 and November 2017 was performed. Charts were divided into (i) mucosa preserving (n=50) and (ii) mucosa non-preserving (n=45) groups. Primary outcomes were nasolacrimal system patency on endoscopic examination and resolution of epiphora. Baseline characteristics were compared with Fisher Exact tests and Mann-Whitney U tests. Generalized estimating equations adjusted for baseline characteristics and accounting for correlation between eyes were used to compare interventions.
Results: Both groups had similar baseline characteristics (p>0.05). Median follow up was 7.9 (IQR 3.6-8.8) and 3.5 (IQR 1.6-4.9) months for groups (i) and (ii), respectively. The odds ratio for a patent lacrimal ductal system was 4.4 (1.2-16.9) with mucosa non-preserving technique. This translated to success in 76.0% (62.3-85.8) of mucosa-preserving and 93.3% (81.3-97.8) of non-preserving cases. Improvement in symptomatic epiphora was not statistically significant (Odds ratio 2.0 (0.7-6.0); 76.0% (62.3-85.8) in the mucosa-preserving group vs. 86.7% (73.3-93.9) in the non-preserving group) Rate of reintervention was significantly higher in the mucosa preserving group (18.0% versus 2.2%, p=0.043).
Conclusions: In this investigation, nasal mucosa non-preserving DCR technique was more likely than mucosa preserving technique to achieve nasolacrimal system patency. However, the improvement in epiphora was not significantly different between groups, although the trend appears to be clinically significant. Future studies should be prospective, randomized and exclude patients with other causes chronic epiphora.