Skip to main content

Prevention of re-obstruction in watery eye treatment: three-flap technique in external dacryocystorhinostomy

Graefe's Archive for Clinical and Experimental Ophthalmology volume 254, pages 2455–2460 (2016)Cite this article

Abstract

Purpose

To examine the surgical outcome of three-flap external dacryocystorhinostomy (3-flap ex-DCR) based on the most common site of granulation occurrence in no-flap endonasal DCR (no-flap en-DCR).

Methods

This was a retrospective observational study. We first examined the location of granulation occurrence in the osteotomy site using nasal endoscopy after no-flap en-DCR on 53 sides of 37 patients (5 male, 32 female) with nasolacrimal duct obstruction. Based on the results of this surgery, we performed 3-flap ex-DCR on 70 sides of 61 patients (18 male, 43 female) with nasolacrimal duct obstruction. Anatomical success was defined as no reflux under lacrimal irrigation and a patent osteotomy site under nasal endoscopic examination at postoperative 12 months. Functional success was defined as no symptoms of watery eyes over the same period.

Results

In the no-flap en-DCR patients, the granulation was formed in 42 sides (79.2 %): 18 sides (34.0 %) on the superior portion, 9 sides (17.0 %) on the inferior portion, 35 sides (66.0 %) on the anterior portion, and only 1 side (1.9 %) on the posterior portion, which was very small. Based on these results, we performed the 3-flap ex-DCR with the anterior, superior, and inferior flaps. Anatomical success with this technique was achieved in all sides (100 %), and functional success was obtained in 66 of 70 sides (94.3 %).

Conclusions

The 3-flap ex-DCR did not cause recurrent nasolacrimal duct obstruction, rendering it a very useful technique in terms of quality of life and medical economics.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Kamal S, Ali MJ (2015) Primary acquired nasolacrimal duct obstruction (PANDO) and secondary acquired lacrimal duct obstructions (SALDO). In: Ali MJ (ed) Principles and practice of lacrimal surgery. Springer, New Delhi, pp 133–141

    Google Scholar 

  2. Serin D, Alagöz G, Karshoğlu Ş, Celebi S, Kükner S (2007) External dacryocystorhinostomy: double-flap anastomosis or excision of the posterior flaps? Ophthal Plast Reconstr Surg 23:28–31

    Article  PubMed  Google Scholar 

  3. Yazici B, Yazici Z (2003) Final nasolacrimal ostium after external dacryocystorhinostomy. Arch Ophthalmol 121:76–80

    Article  PubMed  Google Scholar 

  4. Ali MJ, Psaltis AJ, Bassiouni A, Wormald PJ (2014) Long-term outcomes in primary powered endoscopic dacryocystorhinostomy. Br J Ophthalmol 98:1678–1680

    Article  PubMed  Google Scholar 

  5. Roy H (2011) Fractures and dislocations: general considerations. In: Roy H (ed) Short textbook of surgery. Jaypee Brothers Medical Publishers, New Delhi, p 354

    Chapter  Google Scholar 

  6. Takahashi Y, Nakamura Y, Kakizaki H (2015) Eight-flap anastomosis in external dacryocystorhinostomy. Br J Ophthalmol 99:1527–1530

    Article  PubMed  Google Scholar 

  7. Balikoglu-Yilmaz M, Yilmaz T, Taskin U, Taskapili M, Akcay M, Oktay MF, Eren S (2015) Prospective comparison of 3 dacryocystorhinostomy surgeries: external versus endoscopic versus transcanalicular multidiode laser. Ophthal Plast Reconstr Surg 31:13–18

    Article  PubMed  Google Scholar 

  8. Malhotra R, Wright M, Olver JM (2003) A consideration of the time taken to do dacryo-cystorhinostomy (DCR) surgery. Eye 17:691–696

    Article  CAS  PubMed  Google Scholar 

  9. Takahashi Y, Mito H, Kakizaki H (2015) External dacryocystorhinostomy with or without double mucosal flap anastomosis: comparison of surgical outcomes. J Craniofac Surg 26:1290–1293

    Article  PubMed  Google Scholar 

  10. Elwan S (2003) A randomized study comparing DCR with and without excision of the posterior mucosal flap. Orbit 22:7–13

    Article  PubMed  Google Scholar 

  11. Bukhari AA (2013) Meta-analysis of the effect of posterior mucosal flap anastomosis in primary external dacryocystorhinostomy. Clin Ophthalmol 7:2281–2285

    Article  PubMed  PubMed Central  Google Scholar 

  12. Erdoğan G, Unlü C, Vural ET, Aykut A, Bayramlar H (2010) Inferior flap anastomosis in external dacryocystorhinostomy. Ophthal Plast Reconstr Surg 26:277–280

    Article  PubMed  Google Scholar 

  13. Kakizaki H (2015) Anatomy, physiology, and immunology of the lacrimal system. In: Ali MJ (ed) Principles and practice of lacrimal surgery. Springer, New Delhi, pp 17–33

    Google Scholar 

  14. Hartikainen J, Antila J, Varpula M, Puukka P, Seppä H, Grénman R (1998) Prospective randomized comparison of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy. Laryngoscope 108:1861–1866

    Article  CAS  PubMed  Google Scholar 

  15. Tsirbas A, Davis G, Wormald PJ (2004) Mechanical endonasal dacryocystorhinostomy versus external dacryocystorhinostomy. Ophthal Plast Reconstr Surg 20:50–56

    Article  PubMed  Google Scholar 

  16. Hartikainen J, Grenman R, Puukka P, Seppä H (1998) Prospective randomized comparison of external dacryocystorhinostomy and endonasal laser dacryocystorhinostomy. Ophthalmology 105:1106–1113

    Article  CAS  PubMed  Google Scholar 

  17. Tarbet KJ, Custer PL (1995) External dacryocystorhinostomy: surgical success, patient satisfaction, and economic cost. Ophthalmology 102:1065–1070

    Article  CAS  PubMed  Google Scholar 

  18. Shams PN, Chen PG, Wormald PJ, Sloan B, Wilcsek G, McNab A, Selva D (2014) Management of functional epiphora in patients with an anatomically patent dacryocystorhinostomy. JAMA Ophthalmol 132:1127–1132

    Article  PubMed  Google Scholar 

  19. Malbouisson JMC, Bittar MDR, Obeid HN, Guimaräes FC, Cruz AAV (1997) Quantitative study of the effect of dacryocystorhinostomy on lacrimal drainage. Acta Ophthalmol Scand 75:290–294

    Article  CAS  PubMed  Google Scholar 

  20. Lee H, Takahashi Y, Ichinose A, Kakizaki H (2014) Comparison of surgical outcomes between simple posterior layer advancement of lower eyelid retractors and combination with a lateral tarsal strip procedure for involutional entropion in a Japanese population. Br J Ophthalmol 98:1579–1582

    Article  PubMed  Google Scholar 

  21. Morgan NJ, MacGregor FB, Birchall MA, Lund VJ, Sittampalam Y (1995) Racial differences in nasal fossa dimensions determined by acoustic rhinometry. Rhinology 33:224–228

    CAS  PubMed  Google Scholar 

  22. Cohen AJ, Weinberg DA (2012) Management of the failed dacryocystorhinostomy. In: Black EH, Nesi FA, Gladstone G, Levine MR, Calvano CJ (eds) Smith and Nesi’s ophthalmic plastic and reconstructive surgery, 3rd edn. Springer, New York, pp 689–695

    Chapter  Google Scholar 

  23. Tos M, Ans GB, Perriard A, Balle V (1995) Extranasal microsurgical dacryocystorhinostomy. In: Tos M, Thomsen J, Balle V (eds) Rhinology: a state of the art. Kugler Publications, Amsterdam, p 241

    Google Scholar 

Download references

Acknowledgments

All authors contributed to the work and fit the authorship criteria.

Author information

Authors and Affiliations

  1. Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan

    Hirohiko Kakizaki, Yoshiyuki Kitaguchi, Yasuhiro Takahashi, Jacqueline Mupas-Uy & Hidenori Mito

  2. Ide Eye Hospital, Yamagata, Japan

    Hidenori Mito

Authors
  1. Hirohiko Kakizaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshiyuki Kitaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasuhiro Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jacqueline Mupas-Uy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hidenori Mito
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hirohiko Kakizaki.

Ethics declarations

Funding

No funding was received for this research.

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, other equity interests, 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.

Ethical approval

As there was no ethics committee at Ide Eye Hospital, institutional review board (IRB) approval was obtained from Aichi Medical University Hospital (nos. 2014-H123 and 2015-H135) on behalf of the institution, and followed the tenets of the Declaration of Helsinki. The IRB granted a waiver of informed consent for the study based on the ethical guidelines for medical and health research involving human subjects established by the Japanese Ministry of Education, Culture, Sports, Science and Technology, and by the Ministry of Health, Labour, and Welfare. The waiver was granted because the study was a retrospective chart review, not an interventional study, and because it was difficult to obtain consent from patients who had been treated several years prior. Nevertheless, at the request of the IRB, we published an outline of the study, available for public viewing, on the Aichi Medical University website and on the notice board at Ide Eye Hospital; this also gave patients the opportunity to decline participation. No patient declined to participate. Personal identifiers were removed from the records prior to data analysis.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kakizaki, H., Kitaguchi, Y., Takahashi, Y. et al. Prevention of re-obstruction in watery eye treatment: three-flap technique in external dacryocystorhinostomy. Graefes Arch Clin Exp Ophthalmol 254, 2455–2460 (2016). https://doi.org/10.1007/s00417-016-3490-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-016-3490-z

Keywords

  • Three-flap external dacryocystorhinostomy
  • No-flap endonasal dacryocystorhinostomy
  • Granulation
  • Re-obstruction