Lacrimal Duct Reconstruction with Grafting of Great Saphenous Vein or Labial Mucosa Via Endoscopic Transnasal Dacryocystorhinostomy A group comparison in 18 cases

BACKGROUND: There are no ideal methods for treating severe obstruction of lacrimal ducts in the world. How to improve operation method, select suitable transplantation material, elevate therapeutic efficacy, or to be accepted by patients is a topic of worker of diagnosis and treatment of obstruction of lacrimal ducts. OBJECTIVE: To evaluate the efficacy and safety of lacrimal-lake-nasal lacrimal duct reconstruction with grafting of autogenous great saphenous vein or labial mucosa via endoscopic transnasal dacryocystorhinostomy. DESIGN, TIME AND SETTING: This controlled study was conducted at the General Hospital of Armed Police Force from April 2005 to June 2007. PARTICIPANTS: A total of 18 patients (18 eyes) with severe canalicular obstruction combined with lacrimal sac defect or atrophy were enrolled at the General Hospital of Armed Police Force. METHODS: Two groups were set up according to graft material, including a great saphenous vein group (n = 9) and a labial mucosa group (n = 9). The great saphenous vein group received autogenous great saphenous vein transplantation, whereas the labial mucosa group received autogenous labial mucosa transplantation. Lacrimal duct unobstruction, epiphora improvement and complication were statistically analyzed in patients from both groups following transplantation. MAIN OUTCOME MEASURES: Epiphora improvement during tube wearing after transplantation and irrigation of lacrimal duct after removing the tube were measured. Radioactive nuclide 99Tc(superscript m) (TcO4 (superscript -)) developing examination was used to detect time of entering nose of nuclide to judge therapeutic efficacy. RESULTS: Epiphora in patients from both groups were alleviated in various degrees during 3 months postoperatively, the period with the silicone tube. In the 12(superscript th) week after silicone tube was removed, TcO4 (superscript -) scintigraphy showed eye-nose time was (8.58±4.3) minutes and (9.16±5.8) minutes respectively. There was no significant difference between both groups (P ＞ 0.05). The primarily results showed 6 patients were cured entirely, 2 patients were meliorated, 1 patient with no effects in the great saphenous vein group; 5 patients were cured entirely, 2 patients were meliorated, 2 patients with no effects in the labial mucosa group. CONCLUSION: Lacrimal-lake-nasal lacrimal duct reconstruction with grafting of great saphenous vein or labial mucosa via endoscopic transnasal dacryocystorhinostomy was an effective and safe surgery for treating severe lacrimal duct obstruction. Different grafts had their advantages and disadvantages respectively.