Efficacy and Safety of Adjunctive Triamcinolone in Nasal Endoscopic Dacryocystorhinostomy

Objective: To assess safety and long-term efficacy of use of triamcinolone acetonide (TA) soaked absorbable gel foam dressing in Endoscopic Dacryocystorhinostomy in our population. Study Design: Quasi experimental study Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jan 2016 to Jan 2019. Methodology: Endoscopic Dacryocystorhinostomy was performed on 103 eyes of 98 patients for unilateral or bilateral primary acquired nasolacrimal duct obstruction or previously failed Endoscopic Dacryocystorhinostomy without triamcinolone acetonide. Endoscopic Dacryocystorhinostomy was done using a standardized technique employing a 30° nasal endoscope (Karl Storz, Germany). In addition, a gel foam (15x10x5mm) soaked with 1ml of 40mg triamcinolone acetonide was threaded along the silicone tube metallic guide and advanced to ostium at the end of procedure. Anatomical success (patent lacrimal passage on irrigation), functional success (resolution of epiphora) and complications at 6 and 12 months of follow up, were the outcome measures documented and analyzed. Results: Out of 103 cases, there were 41(39.8%) male and 62(60.2%) female patients. Mean age was 47.10±12.80 years (age range 18–72 years). Anatomical success rate of 90(87.4%) and 89(56.4%) was observed at 6 and 12 months, whereas functional success rate of 88(85.4%) was observed at both 6 and 12 months follow up respectively. No major complications were observed in our study. Conclusion: Endoscopic Dacryocystorhinostomy with triamcinolone acetonide is a safe and effective procedure for epiphora secondary to previous failed Endoscopic Dacryocystorhinostomy or primary acquired nasolacrimal duct obstruction.