Intraoperative Injection of Triamcinolone Acetonide in External Dacryocystorhinostomy

Aim: A prospective and interventional study to known the efficacy and complications of intraoperative triamcinolone acetonide (TMA) 40mg/ml injection in primary external dacrycystorhinostomy ( EXDCR) Material and Methods: Clinically confirmed 38 cases of primary acquired nasolacrimal duct obstruction (PANDO) are randomly grouped as A (Study group) with 20 cases and B (Control group) with 18 cases. Both group underwent primary EXDCR with silicone tube(ST) intubation. Group A cases received 0.5 ml of TMA 40mg/ml and group B 0.5 ml of Gentamycin 40mg/ml injection intraoperatively. Resolution of symptoms and complications of TMA injection are evaluated at 6 months follow up. Result: Mean age, gender and laterality of the eye involvement are not different between two group. The success rate in group A is 90%(18/20) and group B 88.9% ( 16/18), the difference is very small (P=1.0). Raised IOP (Intraocular pressure ) of > 18mmHg observed in 10% (2/20 ) cases of group A. Group A cases had minimal post operative wound inflammation 80%(16/20 ) compare to 44% (8/18) cases in group B.(P= 0.04). Early resolution with cosmetically good scar seen in 90% (18/20) in group A compare to 55.5% ( 10/18) cases in group B (P=0.02). Discussion: Intraoperative TMA injection does not improve the success rate of primary EXDCR in PANDO. But significantly reduces the immediate postoperative wound inflammation and facilitates early resolution of the wound scar. Raised IOP is a concern in TMA injection group