Aesthetic assessment in periciliary “v-incision” versus conventional external dacryocystorhinostomy in Asians

  • Danny Siu-Chun Ng
  • Edwin Chan
  • Derek Kim-Hun Yu
  • Simon Tak-Chuen Ko
Oculoplastics and Orbit
First Online:
Received:
Revised:
Accepted:

Abstract

Purpose

To determine the functional and aesthetic outcomes of periciliary “v-incision” external dacryocystorhinostomy (DCR) and to compare with conventional approach.

Method

Charts review of consecutive cases of “v-incision” (VDCR) or conventional DCR performed in a single institute, between January 2007 and March 2014. All procedures were performed or supervised by a single surgeon. Two periciliary incisions were made near the skin–mucosal junction at the upper and lower eyelid margins medial to the punctum joining at the medial canthal angle to form a “v” shape. Subcutaneous dissection was carried out inferomedially to reach the anterior lacrimal crest. DCR was then performed in the usual manner. Functional success was defined as no persistent or recurrent epiphora and patency on irrigation of the lacrimal drainage system at least 6 months post-surgery. A cross-sectional aesthetic survey was conducted by asking the patients to rate their scar appearance satisfaction on a visual analogue scale (VAS). External photographs were graded by two independent, masked physicians using VAS as well as the Stony Brook scar evaluation scale (SBSES).

Results

Sixty-one patients with median age of 64 years met the inclusion criteria, with median follow-up duration of 28 months. Thirty-eight eyes underwent VDCR, and 23 had conventional DCR. The functional success rate for VDCR was 83.3, 95 % confidence intervals (95%CI) [lower 0.68, upper 0.92] and for conventional DCR was 73.9 %, 95%CI [lower 0.54, upper 0.87]; without statistically significant difference (p = 0.38). VDCR patients rated higher aesthetic outcome on VAS (mean scores 95.5 ± 16.8 vs 82.9 ± 25.1, p = 0.03). On the SBSES, both observers gave higher aesthetic scores to the VDCR group (observer #1 4.6 ± 1.1 and #2 4.7 ± 1.2, p < 0.01) than conventional DCR (observer #1 3.1 ± 2.8 and #2 2.8 ± 2.1, p < 0.01). More patients reported that they could wear spectacles within 1 week post-VDCR (44.7 vs 4.3 %, p < 0.01).

Conclusion

“V-incision” external DCR has a similar functional success rate to that of the conventional approach and has superior aesthetic outcomes as reported by surgeons and patients. However, a higher proportion of trainees under supervision performed conventional DCR, and it is uncertain whether the outcomes were also influenced by the level of surgeon’s expertise.

Keywords

Dacryocystorhinostomy Lacrimal duct obstruction Aesthetics Eyelids surgery 
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Notes

Acknowledgments

We thank Dr. Alvin Chu Po Ngai, Department of Ear, Nose, and Throat, Pamela Youde Nethersole Eastern Hospital, for his contribution as one of the independent, blinded observers for scar evaluation.

Conflict of interest

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Danny Siu-Chun Ng
    • 1
  • Edwin Chan
    • 1
  • Derek Kim-Hun Yu
    • 2
  • Simon Tak-Chuen Ko
    • 1
  1. 1.Department of OphthalmologyTung Wah Eastern HospitalHong KongHong Kong
  2. 2.Champion LASIK and Femtosecond Cataract CentreHong KongHong Kong

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