External dacryocystorhinostomy conventional surgery versus Pawar implant: A comparative study

• Published in: Indian journal of ophthalmology 2019-07, Vol.67 (7), p.1143-1147
• Main Authors: Mishra, Deepak, Bhushan, Prashant, Sinha, Bibhuti, Bhaskar, Gyan, Rao, Raksha
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Child; Chronic dacryocystitis; Comparative analysis; Comparative literature; Dacryocystitis; Dacryocystitis - surgery; dacryocystorhinistomy; Dacryocystorhinostomy; Dacryocystorhinostomy - methods; Dissection; Elevators & escalators; Female; Follow-Up Studies; Gamma rays; Humans; lacrimal; Male; Middle Aged; Nasolacrimal Duct - surgery; nasolacrimal duct obstruction; Ophthalmology; Original; Patients; Pawar's implant; Prospective Studies; Prosthesis Design; Prosthesis Implantation - methods; Silicone Elastomers; Silicones; Skin; Statistical analysis; Success; Surgery; Visualization; Young Adult
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/ijo.IJO_1889_18

Purpose: External dacryocystorhinostomy (DCR) surgeries are cost-effective with excellent success rates. The present study was designed to compare the safety and efficacy of conventional external DCR versus external DCR using Pawar silicone implant in chronic dacryocystitis. Methods: This is a prospective, comparative, interventional case series over a period of 18 months with patients managed by external DCR surgery with and without Pawar implant. Institutional review board approval was obtained before the study. The success of the surgery was objectively measured by sac patency on syringing at the last follow up. Results: A total of 65 patients with chronic dacryocystitis were included in the study. The mean age of patients in the series was 41.43 years (median, 41 years; range, 12 years-60 years). All patients presented with epiphora (100%) and underwent external DCR and were chosen for conventional surgery (n = 33, 51%, group 1) or Pawar silicone implant surgery (n = 32, 49%, group 2) on a random basis. The mean duration of the surgery from the time of skin incision to skin closure for group 1 was 27.7 minutes (median, 26 minutes; range, 21-30 minutes) while in group 2, it was 75.5 minutes (median, 75 minutes; range, 60-88 minutes), which was statistically significant (P < 0.01). The success rate of the procedure done in group 1 was 90% which increased to 97% after the management of failed cases as compared to the success rate in group 2 of 91% and 94%, before and after the management of failed cases, respectively. Conclusion: External DCR using Pawar implant is a safe surgery which is faster than conventional external DCR with almost equal success rates between both the procedures