Lacrimal Plasty with Dacryocystorhinostomy-Anastomosis Using Microsurgery

Background:Dacryocystorhinostomy (DCR) is the standard treatment for nasolacrimal duct obstruction, but it has the disadvantage of creating a raw surface, which may lead to reocclusion due to the development of postoperative granulation tissue. In this study, we developed and evaluated an ideal new surgical method, dacryocystorhinostomy-anastomosis (DCR-A), involving end-to-side anastomosis under microscopic visualization that does not result in raw surfaces. Methods:In DCR, the lateral aspect of the dacryocyst and the nasal mucosa are incised, and the mucosal valves are sutured together. In DCR-A, the occluded section of the dacryocyst or nasolacrimal duct was trimmed and anastomosed by circumferential suturing through a hole in the nasal mucosa. The success rate and the requirement for postoperative therapy were compared between 21 sides of DCR patients and 11 sides of nasal DCR-A patients. Results:DCR-A was significantly better than conventional DCR. No additional postoperative therapy was required for DCR-A. Conclusion:DCR-A improves symptoms of nasolacrimal duct obstruction to a greater extent than conventional DCR and does not require additional postoperative treatment.