Comparison of endoscopic and external dacryocystorhinostomy for treatment of primary acquired nasolacrimal duct obstruction

Su, Pei–Yuan

doi:10.4103/tjo.tjo_10_18

Cited by 27 publications

(18 citation statements)

References 21 publications

(24 reference statements)

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“…Based on their title and abstract, 2,481 papers were judged as ineligible, whereas, based on the plain text, 18 papers were selected ( Figure 1, Table 1). [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] These studies included in the quantitative analysis, following the Oxford CEBM Level of evidence guidance, 20 were described as being level 4 in 14 studies and level 2 in 4 studies. All papers selected were published later than 2000, provided a clear functional success rate and all procedures were performed by a single clinician.…”

Section: Resultsmentioning

confidence: 99%

Impact of Post-Surgical Therapies on Endoscopic and External Dacryocystorhinostomy: Systematic Review and Meta-Analysis

Vinciguerra

Nonis

Resti

et al. 2020

Am J Rhinol�Allergy

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Background Epiphora is a common ophthalmologic sign that is most commonly caused by distal acquired lacrimal obstruction. Recent data have demonstrated that external dacryocystorhinostomy (EXT-DCR) and endoscopic endonasal dacryocystorhinostomy (END-DCR) can be considered the treatments of choice. However, different post-surgical medical therapies are available and are currently used to improve surgical outcomes, although no direct comparison has been performed. Objective To analyse the influence of post-surgical medical treatments on END-DCR and EXT-DCR outcomes. Methods A structured search was conducted using the U.S. National Library of Medicine (PubMed), EMBASE, SCOPUS, and Cochrane databases with a final search performed in May 2020. The research identified papers published later than 2000 with at least 50 single clinician procedures performed in EXT-DCR and END-DCR. Articles that studied acute infections, revision cases, mixed cohort studies of acquired and congenital obstruction, and tumour were excluded. The influence of systemic antibiotic/steroids, local application of mitomycin C, nasal/ocular antibiotic, nasal/ocular steroids and nasal decongestants was analysed. Results In total, 11,445 papers were selected, 2,741 of which were reviewed after screening, and 18 included after full text review (0.6% of the initial articles reviewed) which involved 3,590 procedures. Considering the low number of publications on EXT-DCR, statistical analysis of post-surgical therapy was not feasible. In END-DCR, the analyses were performed only for nasal steroids (p = 0.58), oral antibiotics (p = 0.45) and nasal decongestant (p = 0.27), which demonstrated no meaningful influence. Given the variable association between adjunctive medical therapies, pharmacologic molecular heterogeneity and modality/concentration of application, these results should be considered critically. Additionally, no differences were seen for application of silicone stenting, whereas, no statistical analysis was performed for mitomycin C. Conclusions Given the high success rate of EXT-DCR and END-DCR and the heterogeneity of literature data, the effective influence of post-surgical medical therapy is difficult to identify. Future large prospective randomized studies could help in detecting the optimal adjunctive therapy for these surgeries.

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Section: Resultsmentioning

confidence: 99%

Impact of Post-Surgical Therapies on Endoscopic and External Dacryocystorhinostomy: Systematic Review and Meta-Analysis

Vinciguerra

Nonis

Resti

et al. 2020

Am J Rhinol�Allergy

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“…As sinonasal surgical techniques have become increasingly advanced, the utility of the endonasal EDCR approach has been increasingly explored, as this procedure offers advantages including a reduced need for any external incisions, an associated reduction in the risk of damage to the orbicularis oculi pump mechanism, and the potential for surgeons to simultaneously treat other concomitant intranasal pathologies. 1,2 Despite these advantages, EDCR does have certain challenges and drawbacks as a surgical approach, with the most prominent challenge associated with this procedure being the difficulty of accurately locating the lacrimal sac and avoiding neo-ostium restenosis. 3,4 Dacryocyst localization is typically achieved based on anatomical landmarks including the maxillary line and axils of the middle turbinate.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Long-Term Outcomes Associated With a Lobulated Pedicled Nasal Mucosa Flap Technique for Endoscopic Dacryocystorhinostomy Without Stenting

2020

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Objective: This study describes a surgical approach wherein a lobulated pedicled nasal mucosa flap technique was employed for endoscopic dacryocystorhinostomy (EDCR) as a means of treating nasolacrimal duct obstructions. This study also assessed the long-term outcomes of this EDCR approach when implemented without stenting. Methods: This was a retrospective study of a total of 63 patients (67 eyes) treated for nasolacrimal duct obstructions between January 2011 and November 2016. All patients had undergone ophthalmic diagnosis followed by EDCR treatment using a lobulated pedicled nasal mucosa flap without stenting. Patients were then monitored for both anatomical patency and sustained symptom relief during the follow-up period in order to assess objective and subjective study outcomes. Results: Patients were followed for a mean of 25.3 ± 1.2 months (range: 24-28 months), with a 100% anatomical patency success rate (67/67) and a 94.03% symptomatic cure rate (63/67). There were no instances of complications. Conclusions: The use of a lobulated pedicled nasal mucosa flap technique for EDCR without stenting is a straightforward, effective, and safe approach that keeps bone exposure to a minimum while offering a high rate of satisfactory outcomes, making it a procedure worthy of consideration as a means of treating patients suffering from nasolacrimal duct obstructions.

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“…Su 16 compared the success rate of external DCR with that of endonasal DCR using an endoscope with Kerrison rongeurs and a chisel and hammer as necessary. Functional success was defined at the 6-month visit by resolution of epiphora, and anatomic success was defined as a patent ostium on intranasal endoscopic inspection with successful lacrimal irrigation.…”

Section: Published Resultsmentioning

confidence: 99%

A Comparison of Endonasal Dacryocystorhinostomy and External Dacryocystorhinostomy

et al. 2019

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The search strategy was designed to update the first Ophthalmic Technology Assessment on endonasal DCR from 2001 by identifying new peer-reviewed human studies reported since 2000 in the English language that compare results of endonasal DCR with those of external DCR. The searches yielded 169 articles. Of these, 13 met the inclusion criteria and were assigned a level of evidence rating. Results: Six of the 13 studies included in this assessment were rated level II and 7 were rated level III. Three of the 13 studies drew conclusions based on statistically significant results, but all of these were level III evidence. Two of these significant studies demonstrated lesser efficacy of endonasal laser DCR (63%e64%) compared with external DCR (94%; P ¼ 0.0002, 0.024). The third study reported that nonlaser endonasal DCR was superior to external DCR (84% vs. 70%; P ¼ 0.03). The remainder of the studies did not find statistically significant differences in success rates between the 2 techniques. Conclusions: Limited data suggest that laser endonasal DCR may be less effective than external DCR. Existing data are inadequate to draw conclusions about whether endonasal DCR is superior to, equivalent to, or inferior to the gold standard external DCR. Ophthalmology 2019;126:1580-1585 ª 2019 by the American Academy of Ophthalmology The American Academy of Ophthalmology prepares Ophthalmic Technology Assessments to evaluate new and existing procedures, drugs, and diagnostic and screening tests. The goal of an Ophthalmic Technology Assessment is to review the available research systematically for clinical efficacy, effectiveness, and safety. After review by members of the Ophthalmic Technology Assessment Committee, other Academy committees, relevant subspecialty societies, and legal counsel, assessments are submitted to the Academy's Board of Trustees for consideration as official Academy statements. The purpose of this assessment by the Ophthalmic Technology Assessment Committee Oculoplastics and Orbit Panel is to compare the efficacy of endonasal dacryocystorhinostomy (DCR) with external DCR. HUMAN SUBJECTS: No human subjects were included in this study. No animal subjects were included in this study.

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Comparison of endoscopic and external dacryocystorhinostomy for treatment of primary acquired nasolacrimal duct obstruction

Cited by 27 publications

References 21 publications

Impact of Post-Surgical Therapies on Endoscopic and External Dacryocystorhinostomy: Systematic Review and Meta-Analysis

Impact of Post-Surgical Therapies on Endoscopic and External Dacryocystorhinostomy: Systematic Review and Meta-Analysis

Assessment of Long-Term Outcomes Associated With a Lobulated Pedicled Nasal Mucosa Flap Technique for Endoscopic Dacryocystorhinostomy Without Stenting

A Comparison of Endonasal Dacryocystorhinostomy and External Dacryocystorhinostomy

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