title: Endoscopic-guided trephination dacryocystorhinostomy (Hesham DCR): technique and pilot trial.
abstract: OBJECTIVE
  (1) Test the feasibility and the safety of guided transnasal trephination in creating a nasolacrimal fistula. (2) Develop an appropriate lacrimal maintainer and test its value in modulating healing at the fistula site.
  
  
  METHODS
  Prospective, noncomparative interventional case series.
  
  
  METHODS
  Five cadavers and 19 patients.
  
  
  METHODS
  A transcanalicular lacrimal probe penetrated the lacrimal fossa to guide the passage of a flexible trephine up the nose, which created the nasolacrimal communication. A special wide-caliber lacrimal maintainer was inserted along lacrimal tubes within the created passage.
  
  
  METHODS
  For cadaveric study, direct inspection after dissection of the facial flap was performed. For the clinical trial, subjective improvement in watery eye, dye testing, lacrimal probing, lacrimal irrigation, and endoscopic nasal examination.
  
  
  RESULTS
  The technique resulted in the creation of a regular fistula of reproducible diameter into which a standard-shaped wide caliber maintainer could be inserted. Three months after removal of the maintainer and 6 months after surgery, a patent ostium was achieved in 17 of 18 (94%) patients who had a completed procedure. Relief of symptoms was achieved in 83%.
  
  
  CONCLUSIONS
  Guided endoscopic dacryocystorhinostomy provides a simple and safe option for the treatment of nasolacrimal duct obstruction. The lacrimal maintainer is a useful device to achieve a large patent nasolacrimal communication.
authors.affiliation: Department of Ophthalmology, Alexandria University Hospital, Alexandria, Egypt.
authors.forename: H A
authors.initials: HA
authors.lastname: Ibrahim
authors.forename: J L
authors.initials: JL
authors.lastname: Noble
authors.forename: M
authors.initials: M
authors.lastname: Batterbury
authors.forename: C P
authors.initials: CP
authors.lastname: Johnson
authors.forename: R
authors.initials: R
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003608:Dacryocystorhinostomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007767:Lacrimal Duct Obstruction / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000000981:diagnostic imaging / Q000601:surgery*; D010865:Pilot Projects; D011446:Prospective Studies; D011859:Radiography; D012449:Safety; D016896:Treatment Outcome