Endoscopic dacryocystorhinostomy: long‐term experience and outcomes

Coumou, Adriaan D.; Genders, Stijn W.; Smid, Trudy M.; Saeed, Peerooz

doi:10.1111/aos.13217

Cited by 44 publications

(37 citation statements)

References 33 publications

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“…; Coumou et al. ). A limitation to this study that needs to be taken into account when comparing presented outcome with that of DCR is that the patency of lacrimal drainage system have not been reexamined for the non‐reoperated cases.…”

Section: Discussionmentioning

confidence: 97%

Long‐term outcome of lacrimal stent intubation for complete acquired lacrimal drainage obstructions

Bohman

Kugelberg

Kopp

2019

Acta Ophthalmologica

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Purpose: To investigate long-term outcome and report reoperation rate of noninfected, complete acquired lacrimal drainage obstruction (ALDO) treated with canaliculodacryocystoplasty (CDCP) depending on site of stenosis. Method: Consecutive adult patients with non-infected, complete ALDO treated with CDCP were followed for 76 months. Location of stenosis at preoperative visit and intraoperative probing was recorded, and during follow-up, recurrence of stenosis prompting additional surgery and complications were noted. Survival analysis was applied to compare reoperation rate depending on site of stenosis. A follow-up questionnaire was sent to patients not requiring reoperation asking to grade current epiphora problems. Results: Among 85 included cases (71 patients), 57 were classified as canalicular stenosis and 28 as nasolacrimal duct obstruction (NLDO) preoperatively. At the end of follow-up, 39% (33/85) of cases had required additional surgery due to persistent/recurrent symptoms. No statistical difference was found between these groups.During CDCP, 25 of the 57 preoperatively classified canalicular stenosis were found to have an additional obstruction below the sac. The group with only canalicular stenosis had a statistically significant higher survival compared with cases with NLDO or multiple obstructions (p = 0.03). Of patients responding to the follow-up questionnaire, 11/37 cases experienced epiphora often or constant. Conclusion: Treating complete NLDO with CDCP results in a high reoperation rate and seems an insufficient alternative. Canaliculodacryocystoplasty (CDCP) may be discussed if preoperative examination indicates canalicular stenosis and dacryocystorhinostomy is not desirable. However, the patient needs to be aware of the higher risk for additional surgery, especially if a second stenosis is found during probing.

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Section: Discussionmentioning

confidence: 97%

Long‐term outcome of lacrimal stent intubation for complete acquired lacrimal drainage obstructions

Bohman

Kugelberg

Kopp

2019

Acta Ophthalmologica

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“…Our patient population spans 30 years of a single surgeon's experience performing endo‐DCR surgeries, making it the longest reported longitudinal study for this procedure. Previously published long‐term DCR experiences reported a 14‐year period in The Netherlands and a 13‐year period in Korea . The extended timeline for this study enabled us to capture delayed failures occurring up to 17 years after the initial endo‐DCR procedure, although the average time to failure in our patient population was 2.5 years after primary endo‐DCR.…”

Section: Discussionmentioning

confidence: 99%

Predictors of long‐term success and failure in primary and revision endoscopic dacryocystorhinostomy

Lehmann

Scangas

Jafari

et al. 2019

Int Forum Allergy Rhinol

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Background Although endoscopic dacryocystorhinostomy (endo‐DCR) is a common treatment of nasolacrimal duct obstruction, little is known about the determinants of surgical success and failure. The purpose of this study was to identify patient‐ and technique‐specific factors that may influence surgical outcomes of primary and revision endo‐DCR. Methods A retrospective review was conducted of 596 patients who underwent endo‐DCR over a 30‐year period (1989‐2018). Patients’ demographics and surgical techniques were assessed. Results Among the cohort of patients (n = 478) who underwent primary endo‐DCR, 10% (n = 48) required revision surgery. Patients who failed primary DCR tended to be younger (p = 0.015) and were less likely to have chronic sinonasal inflammation on histopathology (p = 0.047) than the successful surgery group. After adjusting for patient demographics and comorbidities, the occurrence of a postoperative complication was significantly associated with primary DCR failure (odds ratio [OR], 2.2; p = 0.032). Among the cohort of patients (n = 118) who underwent revision endo‐DCR, 8.5% (n = 10) required additional revision surgery. Patients who failed revision DCR tended to be younger (p = 0.022), more likely to have had intraoperative laser usage (p = 0.031), and more likely to have had an intraoperative complication (p = 0.013) than the successful revision surgery group. Endo‐DCR failure was not associated with smoking status, middle turbinate resection, or intraoperative visualization of the internal common punctum (p > 0.05). Conclusion An understanding of factors associated with primary and revision endo‐DCR failure can help to inform preoperative counseling, intraoperative surgical technique, and postoperative care in the treatment of patients with nasolacrimal duct obstruction.

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“…Moreover, with DCT it is possible to remove completely infectious lacrimal sacs and nasal anastomosis is not needed, hence eliminating two possible sites of infections (sac and nasal mucosa) that are still possible after DCR. In fact, the osteotomy itself increase the risk of inflammation/infections ascending from the nasal cavity, even subacute, with an increased frequency of scarring stenosis or angular conjunctivitis [16,17]. Ascending infections and flogosis can be also promoted by Lester-Jones tubes, especially if used in case of negative outcomes of previous DCR.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Surgery of Lachrymal Outflow: Comparison of Techniques with Presentation of a Novel Surgical Dacryocystectomy Variant

Nuzzi¹,

Tridico²

2017

J Clin Exp Ophthalmol

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Objective: The surgical treatment of epiphora and dacryocistitis includes Dacryocystorhinostomy (DCR) and Dacryocystectomy (DCT). To date, dacryocystectomy has been considered a secondary procedure and is not properly considered among the currently available surgical options. Intubation of the lacrimal system often improves surgical outcomes. In this study, a new variant of surgical technique, dacryocystectomy with lacrimal canalicula silicone intubation, is presented. All novel aspects and possible indications are discussed. Methods:Patients with chronic dacryocystitis associated with epiphora and lacrimal stenosis were enrolled for dacryocystectomy with silicon intubation. During follow-up, prevalence of epiphora, disease recurrences and adverse events have been investigated. Also, a retrospective clinical charts comparison with patients that received dacryocystorhinostomy ab externo has been performed.Results: No significant differences were found in terms of postoperative epiphora, silicon tube dislocation and overall adverse events have been observed between the compared groups (p>0.1). Persistent bleeding events were significantly more frequent in the DCR group (p<0.05). No severe adverse events were observed in both groups. Conclusions:Lacrimal intubation may improve classical dacryocystectomy outcomes with greater reduction of the epiphora. This technique, when well indicated (especially following a proper intraoperative clinical evaluation), may provide a decisive resolution of infective/inflammatory lacrimal affections and can avoid intra and postoperative complications associated with DCR.

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Endoscopic dacryocystorhinostomy: long‐term experience and outcomes

Cited by 44 publications

References 33 publications

Long‐term outcome of lacrimal stent intubation for complete acquired lacrimal drainage obstructions

Long‐term outcome of lacrimal stent intubation for complete acquired lacrimal drainage obstructions

Predictors of long‐term success and failure in primary and revision endoscopic dacryocystorhinostomy

Minimally Invasive Surgery of Lachrymal Outflow: Comparison of Techniques with Presentation of a Novel Surgical Dacryocystectomy Variant

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