A clinical trial of endoscopic vs external dacryocystorhinostomy for partial nasolacrimal duct obstruction

Abstract

Objective A literature review revealed there is no outcome data for endoscopic endonasal dacryocystorhinostomy (EES-DCR) in the subgroup of patients with acquired partial nasolacrimal duct obstruction (NDO). This study aimed to compare the results of EES-DCR vs external DCR (ext-DCR) in the treatment of partial NDO. Design This study is designed as a prospective nonrandomised comparative clinical trial. Participants In total, 46 adult patients with acquired partial NDO participated in this study. Methods Partial (sometimes called 'functional') NDO (epiphora in the presence of patent syringing) was confirmed by nuclear lacrimal scintigraphy or delayed drainage on dacryocystography. Patients with 'functional' epiphora from other causes were excluded. Post-operative outcome was assessed at 6 months. Overall, 21 (46%) patients had EES-DCR and 25 patients had (54%) ext-DCR. Main Outcome Measures Subjective success was based on patient symptoms, objective success on patency with syringing and a functioning rhinostomy evaluated using the functional endoscopic dye test (FEDT). Results In total 18 out of 21 (86%) of EES-DCR patients had marked reduction (n ¼ 11) or complete resolution (n ¼ 7) and 25 out of 25 (100%) of ext-DCR had marked reduction (n ¼ 9) or complete resolution (n ¼ 16) of epiphora. In total 17 out of 18 (94%) of the EES-DCR patients with subjective success had a positive FEDT. All 25 out of 25 (100%) ext-DCR patients with subjective success had a positive FEDT. The three failed EES-DCR patients were all blocked on syringing. Statistically, EES-DCR does not achieve the same success rate as ext-DCR in this study (P ¼ 0.09, two-tailed Fisher's exact test, 0.045 one-tailed). Conclusions Both endoscopic and external DCRs provide satisfactory outcomes in acquired partial NDO. The success rate is nevertheless higher in ext-DCR compared with EES-DCR.

Practice patterns in endoscopic dacryocystorhinostomy: survey of the American Rhinologic Society

“…EnDCR has been shown to demonstrate comparable high success rates compared with external DCR through multiple prospective studies . An endoscopic approach has many advantages compared to the external approach, which includes improved visualization, lack of an external scar, preservation of the lacrimal pump function, correction of any associated sinonasal pathology, and less operative time.…”

Changes in cytokines in tears after endoscopic endonasal dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction

“…2,3 Although previous reports have shown lower success rates than transcutaneous DCR, recent advances in technique have resulted in the endoscopic endonasal DCR being comparable to external DCR. [4][5][6] The tears contain a variety of cytokines and growth factors required to maintain homeostasis of the ocular surface. Changes in the cytokines of the tears may reflect an underlying pathophysiologic condition.…”

About endonasal laser dacryocystorhinostomy unfavorable outcomes

“…Так, например, имеются данные, согласно которым процент недостаточно эффек-тивных оперативных вмешательств составляет 5-16 % при наружном доступе и до 40 % при эндоскопическом [10,11]. Существуют также данные ретроспективного исследования 77 па-циентов, подвергшихся ревизионной ДЦРС, в результате которого также выяснилось, что успешность эндоскопической дакриоцисторино-стомии несколько меньше (80,7 %), чем наружной (84 %) [13]. Другие авторы, называя результаты как эндоскопической, так и наружной операции удовлетворительными, также свидетельствуют о более высокой успешности наружного подхода.…”

“…Это хирургическое вмешательство и сегодня оста-ётся основным способом лечения стенозов и зара-щений носослёзного канала и хронических дакрио-циститов, частота которых, по данным литературы, составляет от 2 до 9,2 % пациентов офтальмологи-ческих клиник [3,4,13].…”