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In reply

Dhage, SS

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Indian Journal of Ophthalmology: Jan–Mar 2002 - Volume 50 - Issue 1 - p 69-70
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We thank Dr. S.S. Dhage for his interest in our article.[1] His reported experience is to be commended. However, as members of the ophthalmic community it is incumbent on us to offer our patients all the options available to alleviate their problems. Supported with the data presented in our paper it is possible to offer them an informed choice. Our paper does not recommend 5-Fluorouracil-augmented Endonasal Dacryocystorhinostomy (5 FU-ENL) for all patients; in no uncertain terms it spells out the lower success rate of a single procedure (94.7% for EXT-DCR versus 63.6% for 5 FU-ENL). The success rate increases with additional laser procedures.[23]

Though at our centre one of the authors, an ENT surgeon (HW), has a particular interest in ENL and the procedure is performed as a team, currently in the UK the procedure is done by ophthalmologists independently. Both procedures cost the same in our health care system.

With reference to the points enumerated regarding the surgical techniques of EXT-DCR, it was not our intention to reiterate surgical principles that are well established.[45] Facial scaring, lacrimal pump failure, and bleeding are real problems in our group of patients and when offered an informed choice 90% of our patients elect to have ENL. This does not reflect the failure to adhere to sound surgical principles.

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1. Watts P, Ram AR, Nair R, Williams H. Comparison of external dacryocystorhinstomy and 5-Fluorouracil augmented endonasal laser dacryocystorhinstomy. A retrospective review Indian J Ophthalmol. 2001;49:169–72
2. Woog JJ, Metson R, Puliafito CA. Holmium: YAG endonasal laser dacryocystorhinostomy Am J Ophthalmol. 1993;116:1–10
3. Kong YT, Kim TI, Kong BW. A report of 131 cases of Endoscopic Lase Lacrimal Surgery Ophthalmology. 1994;101:1793–1800
4. Toti A. iNvovo metodo conservatore di cura radicale delle suppurazioni croniche del sacco lacrimale (Dacriocistorinostomia) Clin Mod Firenze. 1904;10:385–87
5. Dupuy-Dutemps Bourguet. Procede plastique de dacryocystorhinostomie et ses resultats Ann Ocul. 1921;158:241–61
© 2002 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow