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Brief resume of the intended work


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  1. BRIEF RESUME OF THE INTENDED WORK:


6.1 NEED FOR THE STUDY:
Epiphora is an imperfect drainage of tears through the lacrimal passage. The most commonest cause being chronic dacryocystitis.
The traditional surgical approach to the chronic dacryocystitis has been by an external skin incision. Relatively high success rate of this procedure does not however detract from its limitations. The advent of the rigid endonasal endoscope and the development of functional endoscopic sinus surgery techniques have awakened interest in endonasal endoscopic dacryocystorhinostomy. This has now been able to provide an alternative approach to the treatment of epiphora where the cause is obstruction distal to the common canaliculus.
Since the study has not been done in and around Bangalore to compare the results of both the procedures this study aims at comparing the results of external dacryocystorhinostomy and endonasal endoscopic dacryocystorhinostomy.


6.2 REVIEW OF LITERATURE:
Jauko Harkikainen et al¹ (1998)- conducted a prospective randomized comparative study of 64 cases, 32 cases in each group underwent two different procedures, the success rate after a final follow up of 1 year was 91% for external dacryocystorhinostomy and 75% for endonasal endoscopic dacryocystorhinostomy after primary surgery. The difference was not statistically significant (p=0.18). The success rate after secondary surgery was 97.22% in both study groups. They concluded that external dacryocystorhinostomy when compared with endonasal endoscopic dacryocystorhinostomy gives a higher although not statistically significant primary success rate indicating that these two different dacryocystorhinostomy techniques are acceptable alternatives.
A study was conducted by S.Davis et al(1999) in Christian Medical College Hospital at Vellore, India to compare external dacryocystorhinostomy and endonasal endoscopic dacryocystorhinostomy. There were 16 cases in each group, the success rate was 93.8% for external dacryocystorhinostomy and 100% for endonasal endoscopic dacryocystorhinostomy. Although the success rate was not statistically significant. They concluded that same level of success can be achieved by both the method.
Another study was conducted by V.P.Venkatachalam and Sanjay Agarwal³ (2000) in the department of otolaryngology in Safdarjung Hospital, New Delhi. 30 patients underwent endonasal endoscopic dacryocystorhinostomy. Out of these 28 patients were symptom free after follow up period of 6-18 months. However 2 patients (6.7%) had recurrence of symptoms 2-3 weeks following surgery. The result of endonasal endoscopic dacryocystorhinostomy for post saccal stenosis was 93.3%.
Dolman P.J. (2003); Conducted retrospective non randomized comparative interventional case series study. A total 354 consecutive cases of DCR were reviewed in 349 patients performed by one surgeon over 4 year period with minimum 1 year follow up who had undergone either External-Dacryocystorhinostomy or Endonasal endoscopic DCR. A total of 153 external-DCR and 201 endonasal endoscopic DCR patients were identified, outcome were graded as full success, partial success or failure. The results were full success in 90.2% for external DCR and 89.1% for endonasal endoscopic DCR, partial success was recorded in 2.0%. External DCR and 4% Endonasal endoscopic DCR, failure rate was 7.8% for External DCR and 7.0% Endonasal endoscopic DCR. Mean operative duration was 34.3 minutes for External DCR and 18.5 minutes for Endonasal endoscopic DCR (p<0.0001; T test). The conclusion was Endonasal endoscopic DCR approach is more rapid than the traditional external approach has an equivalent surgical success rate.

6.3 OBECTIVES OF THE STUDY:
1. To compare the results of external dacryocystorhinostomy and endonasal endoscopic dacryocystorhinostomy.


  1. MATERIALS AND METHODS:


7.1 SOURCE OF DATA:
All patients attending ophthalmology OPD at M.S.Ramaiah Hospital for the symptom of epiphora from period between June 2007 to June 2009.



    1. METHOD OF COLLECTION OF DATA:


INCLUSION CRITERIA:


  1. All symptomatic epiphora cases diagnosed for primary acquired nasolacrimal duct obstruction or chronic dacryocystitis.

  2. Those who were willing to undergo surgery.



EXCLUSION CRITERIA:


  1. Epiphora with no signs of lacrimal drainage obstruction on sac syringing

  2. Ectropion / Entropion / Lower lid laxity

  3. Canalicular and punctal obstruction.

  4. Post traumatic bone deformity.

  5. History of radiation therapy.

  6. History of sinonasal malignancy and granulomatous conditions.



SAMPLE SIZE:
All cases of epiphora which fulfills the inclusion and exclusion criteria will be taken for external dacryocystorhinostomy and endonasal endoscopic dacryocystorhinostomy randomly from the period of June 2007 to June 2009 as a time bound study. (approximately 50 cases i.e. 25 cases for each by hospital statistics)
FOLLOW UP:
Will be done after 1st week, 1st month, 3rd month and 6th month.



    1. DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?


YES, the following investigations have done as indicated by clinical condition.
Blood Investigations

  1. Hemoglobin percentage

  2. Total count

  3. Differential count

  4. Erythrocyte sedimentation rate

  5. Bleeding and Clotting time

Urine Examination



  1. Albumin

  2. Sugar

  3. Microscopy

X-ray paranasal sinuses


For the patients undergoing surgical intervention, an informed written consent will be taken before surgical procedures.


    1. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?


YES, and ethical clearance certificate is enclosed herewith.


  1. LIST OF REFERENCES:




        1. Harikikainen J, et al – “Prospective Randomized Comparative Study of External Dacryocystorhinostomy and Endonasal Endoscopic Dacryocystorhinostomy”

Laryngoscope 108, December 1998; (1861-1866)


        1. Davies et al – “A Comparative Study of External and Endonasal Endoscopic Dacryocystorhinostomy” A preliminary report.

Indian Journal of Otolaryngology and Head and Neck Surgery, Vol 52, No 1, December 1999 – March 2000; pg 37-39.


        1. Venkatachalam V.P and Sanjay Agarwal “Endoscopic Dacryocystorhinostomy”.

Indian Journal of Otolaryngology and Head and Neck Surgery, Vol 52, No 4, October – December 2000; pg 371-372.


        1. Dolmon P J “Comparison of External Dacryocystorhinostomy with Non Laser Endoscopic Endonasal Dacryocystorhinostomy”.

Ophthalmology 2003 Jan; 110(1);78-84.


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