Prospective Comparison of 3 Dacryocystorhinostomy Surgeries

Balikoglu-Yilmaz, Melike; Yılmaz, Tolga; Taşkın, Ümit; Taşkapili, Mühittin; Akçay, Mehmet Erdem; Oktay, Mehmet Faruk; Eren, Şaban

doi:10.1097/iop.0000000000000159

Cited by 38 publications

(8 citation statements)

References 39 publications

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“…Prior studies evaluating operative time for external DCR using traditional tools have reported mean times between 46.6 mins and 56.2 mins. 5,10 We report an average operative time of 38.9 mins with the UBA, compared to 44.7 mins with the high-speed drill (p=0.01). This finding validates earlier research from Czyz et al, who suggested anecdotal improvements in operative time when using a piezosurgical device.…”

Section: Discussionmentioning

confidence: 84%

<p>External Dacryocystorhinostomy: A Comparison Of Ultrasonic Bone Aspiration To High-Speed Drilling</p>

Shankar¹,

Kalyam²,

Couch³

2019

OPTH

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Purpose: Piezosurgical tools utilize high-frequency ultrasonic oscillations to selectively cut mineralized bone and minimize damage to soft tissue and mucosa. The purpose of this study was to directly compare outcomes in external dacryocystorhinostomy (DCR) using a piezoelectric ultrasonic bone aspirator (UBA) versus a high-speed electric drill with a diamond burr. Methods: A retrospective chart review was conducted on 145 consecutive patients who underwent external DCR by a single oculoplastic surgeon between 2012 and 2017. Collected data included baseline patient characteristics, presenting symptoms, operative details and complications, and postoperative symptoms. Results: One hundred and seventy-three primary external DCRs performed on 145 patients were included in this study. In total, 61.3% of cases were performed with the UBA and 38.7% with the high-speed drill. Most patients were white (92.4%) and female (67.6%), with a mean age of 57.6 years (range 1-93). Surgical success was achieved in 94.3% of patients in the UBA group and 94.0% in the drill group, with no significant differences between the two arms (p=0.36). Patients who experienced persistent nasolacrimal duct obstruction after surgery underwent endoscopic revision. Operative time was shortened for cases utilizing the UBA (38.9 mins) instead of the high-speed drill (44.7 mins; p=0.01). No significant intraoperative complications occurred in either group. Conclusion: The UBA offers comparable outcomes and complication rates to more conventional surgical tools for external DCR. Excellent outcomes, ease of adoption, and potential surgical time savings make the UBA an appealing option for both novice and experienced surgeons.

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Section: Discussionmentioning

confidence: 84%

<p>External Dacryocystorhinostomy: A Comparison Of Ultrasonic Bone Aspiration To High-Speed Drilling</p>

Shankar¹,

Kalyam²,

Couch³

2019

OPTH

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“…[ 12 , 15 ] The prospective studies had a low risk of bias in four studies and a moderate risk of bias in five studies. [ 13 , 14 , 16 - 22 ] A risk of bias assessment is presented in Fig. 2 and Table 2 .…”

Section: Resultsmentioning

confidence: 99%

Success and complications of endoscopic laser dacryocystorhinostomy vs. external dacryocystorhinostomy: A systematic review and meta-analysis

Panda,

Nayak,

Mohapatra

et al. 2023

Indian Journal of Ophthalmology

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A systematic review and meta-analysis were conducted to evaluate the success and complications of endoscopic laser dacryocystorhinostomy (ELDCR) vs. external dacryocystorhinostomy (ExDCR) in primarily acquired nasal duct obstruction. The search of PubMed, Embase, and Cochrane Central Register of Controlled Trials databases revealed 109 studies on ELDCR and ExDCR. Eleven studies were found to be suitable for review. The primary objective was to compare the success rate between ELDCR and ExDCR. The secondary objectives were to analyze the surgical time, overall complications, bleeding, infection, intranasal synechia, and granulation tissue. Pooled analysis of all studies revealed that ELDCR had a significantly lesser success rate compared to ExDCR (80.3% vs. 91.6%; odds ratio [OR] 0.41; 95% confidence interval [CI] [0.27, 0.62]; P < 00001; I2 = 13%). However, there were no difference in the overall complication rate (12.0% vs. 13.0%; OR 1.04; 95% CI [0.17, 6.33]; P = 0.97, I2 = 80%) and intranasal synechiae (9.5% vs. 4.3%; OR 2.22 [1.04, 4.72]; P = 0.04; I2 = 10%). The ExDCR group had significantly increased risks of bleeding (1.9% vs. 13.0%; OR 0.20; 95% CI [0.09, 0.47]; P = 0.0002; I2 = 0%) and infection (0.3% vs. 4.6%; OR 0.09; 95%CI [0.02, 0.51]; P = 0.006; I2 = 0%). Nevertheless, ELDCR needed a shorter surgical time compared to ExDCR (mean difference [MD] −28.35, 95% CI [−35.45, −21.26], P < 0.00001, I2 = 78%). Although ELDCR is associated with lesser bleeding, lesser infection, and shorter surgical duration, the success rate of ExDCR is higher.

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“…In this study, the anatomical and functional success of T-DCR was 83% and 73% respectively, according to the worldwide literature. [12][13][14][15][16][17][18][19] Although the success rates of T-DCR are lower than that of Ext-DCR and mechanical endoscopic DCR, it has some advantages, such as no facial scars, shorter surgical time, minimal patient discomfort, the possibility of local anesthesia, minimal morbidity, lower risk of bleeding, and fast patient recovery. 12,13,20,21 Anatomical success of DCR is usually assessed performing lacrimal irrigation tests.…”

Section: Discussionmentioning

confidence: 99%

Air Bubble Test Versus Endoscopic Jones I Test in Assessment of Anatomical and Functional Success After Diode Laser Transcanalicular Dacryocystorhinostomy

Feijó

Caixeta

Matayoshi

2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To compare the accuracy and positive predictive values of the air bubble test (ABT) and endoscopic Jones I test for assessment of anatomical and functional success after diode laser transcanalicular dacryocystorhinostomy (T-DCR). Methods: This cross-sectional study included 60 eyes of 56 patients who underwent T-DCR by a single surgical team from January 2016 to December 2018. All the 56 patients (60 eyes) underwent lacrimal syringing, endoscopic Jones I test, and ABT. Anatomical success was considered as a free passage of fluid with no reflux on the irrigation test. Functional success was defined as the resolution or improvement of epiphora (Munk score of 0 or 1). The results of irrigation test, endoscopic Jones I test, and ABT were used to calculate the accuracy and positive predictive values (PPVs) of ABT and endoscopic Jones I test for assessment of anatomical and functional success (Munk score of 0 or 1) after T-DCR. A value of p < 0.05 was considered statistically significant. All statistical evaluations were performed using SPSS software. Results: There were 60 T-DCR procedures in 56 patients (82.1% women; 46 patients) with a mean age of 56.4 years (standard deviation: 15.7; range from 29 to 92). The mean follow up was 8.1 months. Overall anatomical and functional success rates were 83.3% (50/60) and 73.3% (44/60), respectively. The PPV of endoscopic Jones I test in anatomical success and functional success was 100% and 88%, respectively. The accuracy of this test in anatomical and functional success was 100% and 81.25%, respectively. The PPV of ABT in anatomical success and functional success was 100% and 90.4%, respectively. The accuracy of this test in anatomical and functional success was 92% and 80.65%, respectively. Conclusions: In conclusion, both endoscopic Jones I test and ABT showed PPV of 100% to detect anatomical success after T-DCR; the endoscopic Jones I test and ABT had 88% and 90.4% of PPV on evaluation of functional success, respectively. Both tests showed good accuracy in the assessment of anatomical and functional success after T-DCR. These outcomes may indicate that ABT could substitute Jones I test on postoperative DCR assessment.

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Prospective Comparison of 3 Dacryocystorhinostomy Surgeries

Abstract: External DCR, EN-DCR, and TC-DCR had similar success and complication rates in patients with primary acquired nasolacrimal duct obstruction. External DCR resulted in the largest ostium size. Transcanalicular DCR appeared to be effective with the shortest surgical time.

Cited by 38 publications

References 39 publications

<p>External Dacryocystorhinostomy: A Comparison Of Ultrasonic Bone Aspiration To High-Speed Drilling</p>

<p>External Dacryocystorhinostomy: A Comparison Of Ultrasonic Bone Aspiration To High-Speed Drilling</p>

Success and complications of endoscopic laser dacryocystorhinostomy vs. external dacryocystorhinostomy: A systematic review and meta-analysis

Air Bubble Test Versus Endoscopic Jones I Test in Assessment of Anatomical and Functional Success After Diode Laser Transcanalicular Dacryocystorhinostomy

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