title: Outcomes of endoscopic dacryocystorhinostomy: Experience of a fellowship trainee at a tertiary care center.
abstract: OBJECTIVE
  The study aims to report a single trainee's experience of learning and performing endoscopic endonasal dacryocystorhinostomy (En-DCR).
  
  
  METHODS
  This study was a retrospective, interventional case series.
  
  
  METHODS
  Fifty-four eyes of fifty patients presenting at a tertiary eye care center over 1 year were included in the study. All cases underwent endoscopic DCR with mitomycin-C and silicone intubation. The parameters studied included demographics, clinical features, intraoperative details, and postoperative ostium evaluation. Stent removal and nasal endoscopy were performed at 6 weeks and a further ostium evaluation at 3 and 6 months following surgery. Anatomical success rate was defined as patent irrigation, and functional success rate was defined as positive functional endoscopic dye test and absence of epiphora.
  
  
  RESULTS
  Fifty-four eyes of fifty patients were operated, and three cases were lost to follow-up after surgery. The mean age at presentation was 34 (4-75) years. Clinical diagnosis included primary acquired nasolacrimal duct (NLD) obstruction in 72% (39/54), acute dacryocystitis in 15% (8/54), failed DCR in 7% (4/54), and persistent congenital NLD obstruction in 5% (3/54). The first five cases needed intervention by the mentor for superior osteotomy. Common variations in anatomical landmarks were posterior location of sac, large ethmoidal bulla, high internal common opening, and thick maxillary bone. Surgical time taken in the last 27 eyes was significantly lesser compared to the surgical duration taken in the initial 27 cases (P < 0.05). Anatomical and functional success rate was 94% (48/51) at 6 months follow-up period.
  
  
  CONCLUSIONS
  Endoscopic En-DCR has a good success rate when performed by oculoplastic surgery trainees. Nasal anatomical variations, instrument handling, and adaptation to monocular view of endoscope are few of the challenges for beginners. Structured skill transfer can help trainees to learn and perform En-DCR with acceptable success rates.
authors.affiliation: Ophthalmic Plastic Surgery, Eyehub, Faridabad, Haryana, India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kamal
authors.affiliation: Department of Ophthalmic Plastic Surgery, Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, Telangana, India.
authors.forename: Mohammad Javed
authors.initials: MJ
authors.lastname: Ali
authors.affiliation: Department of Ophthalmic Plastic Surgery, Advanced Eye Hospital and Institute, Navi Mumbai, Maharashtra, India.
authors.forename: Akshay Gopinathan
authors.initials: AG
authors.lastname: Nair
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000477:Alkylating Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003608:Dacryocystorhinostomy / Q000379:methods*; D004503:Education, Medical, Graduate; D004724:Endoscopy; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D007440:Intubation; D007767:Lacrimal Duct Obstruction / Q000628:therapy*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009301:Nasolacrimal Duct / Q000601:surgery; D009885:Ophthalmology / Q000193:education*; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents; D062606:Tertiary Care Centers
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin