Endoscopic-guided trephination dacryocystorhinostomy (Hesham DCR) - Technique and pilot trial

Objectives: (1) Test the feasibility and the safety of guided transnasal tr ephination in creating a nasolacrimal fistula. (2) Develop an appropriate l acrimal maintainer and test its value in modulating healing at the fistula site. Design: Prospective, noncomparative interventional case series. Participants: Five cadavers and 19 patients. Method: A transcanalicular lacrimal probe penetrated the lacrimal fossa to guide the passage of a flexible trephine up the nose, which created the nas olacrimal communication. A special wide-caliber lacrimal maintainer was ins erted along lacrimal tubes within the created passage. Outcome Measures: For cadaveric study, direct inspection after dissection o f the facial flap was performed. For the clinical trial, subjective improve ment in watery eye, dye testing, lacrimal probing, lacrimal irrigation, and endoscopic nasal examination. Results: The technique resulted in the creation of a regular fistula of rep roducible diameter into which a standard-shaped wide caliber maintainer cou ld be inserted. Three months after removal of the maintainer and 6 months a fter surgery, a patent ostium was achieved in 17 of 18 (94%) patients who h ad a completed procedure. Relief of symptoms was achieved in 83%. Conclusions: Guided endoscopic dacryocystorhinostomy provides a simple and safe option for the treatment of nasolacrimal duct obstruction. The lacrima l maintainer is a useful device to achieve a large patent nasolacrimal comm unication. (C) 2001 by the American Academy of Ophthalmology.