Nasolacrimal recanalization as an alternative to external dacryocystorhinostomy for treating failed nasolacrimal duct intubation

Abstract

To compare the surgical duration and clinical outcomes of nasolacrimal recanalization versus external dacryocystorhinostomy (DCR) in the treatment of failed nasolacrimal duct intubation.This is a retrospective, comparative, and interventional study. We evaluated the outcomes of 66 consecutive patients undergoing either nasolacrimal recanalization (n = 32) or DCR (n = 34) in a tertiary lacrimal disease referral center. Length of surgical duration, clinical outcomes, and rate of recurrence at 18 months postoperatively were compared.The mean surgical duration was 18.5 minutes (range, 15–25 minutes) for nasolacrimal recanalization and 48.2 minutes (range, 45–61 minutes) for DCR, respectively (P < 0.001). The rate of success was 84.4% in the recanalization group and 85.3% in the DCR group, respectively (P = 0.91). The time to recurrence was 2.6 ± 1.1 months in the recanalization group and 5.6 ± 2.1 months in the DCR group (P < 0.001). Five failed cases in each group received a secondary DCR surgery with the same resolution rate (40%). The absence of ocular discharge at baseline was a significant predictor for a successful outcome in the recanalization group (P = 0.04) but not in the DCR group (P = 0.63).Nasolacrimal recanalization is an effective, safe, and time-saving alternative to DCR for the treatment of failed nasolacrimal duct intubation. Clinicians should be cautious in patients with discharge.

3D morphological classification of the nasolacrimal duct: Anatomical study for planning treatment of tear drainage obstruction

“…Endoscopic DCR is increasing in popularity among ophthalmologists because its application can avoid external scarring, but is accompanied by risk due to the use of general anesthesia (Duffy, 2000). Nasolacrimal recanalization is a recently‐introduced endoscopic surgical procedure to treat NLD obstruction that consists of retrograde removal of obstructing tissues using electrocauterization (Hong et al, 2016). This procedure is an effective, safe, simple, and minimal invasion approach to treat NLD obstruction with a high success rate (Agrawal, Gupta, Singh, & Agrawal, 2013; Boush, Lemke, & Dortzbach, 1994; Chen et al, 2009).…”

Modified external revision-DCR in previous failed endonasal, transcanalicular or external-DCR: technical strategy and teaching Pearls for success

“…All our modified revised or primary modified Ex-DCR cases had both anterior and posterior sacco-mucosal flaps that may have contributed to the high success rates. Although some alternative approaches have been suggested for the treatment of failed cases, such as nasolacrimal recanalization (84.4%) [ 14 ], traditional approaches regarding the success rates of rDCRs revealed that rEE-DCR with silicone tube intubation has been reported to have a success rate of about 82.0% [ 15 ]. In the present Ex-DCR revision, none of the cases, except for 6 patients with atrophic sacs, required stent implantation, and the success rate was higher with the aid of sufficient bony opening in a proper location and anterior sacco-mucosal suspension.…”

Comparison of the efficacies of 1.0mm and 1.5mm silicone tubes for the treatment of nasolacrimal duct obstruction

“…Lacrimal recanalization surgery includes endoscopic-guided trephination dacryocystorhinostomy, dacryorhinotomy, microdrill dacryoplasty, laser dacryoplasty, and anterograde balloon dacryoplasty. [3][4][5][6][7][8][9][10] Silicone intubation or anterograde balloon dacryoplasty with a silicone tube intubation is commonly employed to treat a partial obstruction or stenosis of the lacrimal duct. [11][12][13] In Northeast Asia, silicone intubation has been proposed as an alternative to DCR in the treatment of post-saccal obstruction.…”