Modified method of ostium intubation after endonasal endoscopic dacryocystorhinostomy
Introduction. The use of bicanalicular lacrimal implants designed to prevent ostium scarring after endonasal endoscopic dacryocystorhinostomy (EEDCR) may cause a number of complications. The use of Monoka monocanalicular implants (FCI, France) after EEDCR is not covered in the Russian scientific literature at all. Methods. 61 EEDCRs were performed in 56 patients with lacrimal pathway (LP) obstruction at the level of lacrimal sac cervix. In 29 cases, a new method of ostium intubation with two Monoka monocanalicular lacrimal implants (FCI, France) (that was proposed by the authors) was applied (group 1). In the remaining 32 cases, Bika bicanalicular implants (FCI, France) were used (group 2). Besides routine dacryological assessment, all patients underwent multislice computed tomography (MSCT), in which was LP were contrast-enhanced according to an original technique. Before being enrolled in either group, patients were standardized according to proposed criteria, which were based on the MSCT ones. LP extubation was performed 3 months after surgery. The follow-up period was 12 months. The following parameters were evaluated: subjective epiphora (Munk’s scale), dye test results, LP patency (irrigation test), and the shape of the ostium (nasal endoscopy). Results. Judging from the results of a comprehensive examination; favorable outcomes were achieved in 89.7% (26 cases) of patients from group 1, and in 90.6% (29 cases) of patients from group 2. In group 2, a number of complications were observed: lacrimal implant dislocation (3 cases, 9.4%), corneal epitheliopathy (2 cases, 6.2%), toxic allergic conjunctivitis (2 cases, 6.2%), lacrimal canaliculi dissection (1 case, 3.1%), lacrimal point ectopy (1 case, 3.1%), granulations within lacrimal canaliculi (1 case, 3.1%), and pterygium progression (1 case, 3.1%). In group 1, neither of the above mentioned complications occurred. Conclusion. For ostium intubation after EEDCR, with two Monoka monocanalicular lacrimal implants (FCI, France) passed through both the upper and lower lacrimal canaliculi is preferable in comparison with bicanalicular intubation using «Bika» (FCI, France).