A retrospective comparison of endonasal KTP laser dacryocystorhinostomy versus external dacryocystorhinostomy

Abstract

We retrospectively reviewed all primary external dacryocystorhinostomies (DCRs) and endonasal KTP laser DCRs performed for epiphora as a result of nasolacrimal duct obstruction in our unit between 1993 and 2000. Forty-nine patients underwent an external approach and 76 endonasal laser procedures were performed. The success rate of the external group was 94% with a mean follow-up of 9 months. In contrast, the endonasal group's success rate was 64% with a mean follow-up of 12 months. This difference reached statistical significance (P = 0.0002). However, when including revision procedures, the success rate in the endonasal group increased from 64% to 82%. The success rate in the endonasal group improved from 50% in the first 38 cases to 79% in the last 38 cases (P = 0.0084), thereby demonstrating a learning curve. Our study confirms external DCR as the 'gold standard' for a successful outcome. However, the endonasal technique has significant advantages, including being a quicker procedure with less morbidity, no cutaneous scar, and being more amenable to a bilateral procedure, daycase surgery and local anaesthetic. We are persisting with the endonasal technique because of its advantages but have moved towards more 'cold steel' techniques in an effort to improve results and emulate other series. In conclusion, for nasolacrimal duct obstruction, the endonasal technique is our approach of choice, with revision surgery if necessary, and the external technique is held in reserve.

Prospective Randomised Comparative Study O F External Dacryocystorhinostom Y and Endoscopic Dacryocystorhinostomy

“…The success rate in case of Group II was 76% (19 cases) and 6 cases (24%) were failure. 4 Ibrahim et al 12 and Mirza et al 13 However, when compared to Cokkesser et al, 11 Dolman P. J 10 and Tsirbas et al, 5 our Endoscopic DCR group has a lower success rate.…”

Learning Curve in External DCR – A Trainee’s Perspective

“…Similarly, Watts et al (2001) reported a success rate of 94.7% in 19 patients at 12 months and Mirza et al (2002) reported a success rate of 94% in 49 patients after a mean follow-up of 9 months. All the surgeons in the above studies were highly experienced, with at least 10 years of experience in ophthalmology (Watts et al, 2001;Mirza et al, 2002;Besharati et al, 2005;Karim et al, 2011). In a study similar to ours, Besharati et al (2005) reported success rates of 88% in 149 patients in a teaching hospital in Iran, with a follow-up range of 3 months to 2 years.…”

“…Mirza et al (2002) found an improved outcome in the last 38 cases of endonasal DCR out of a total of 76 cases but did not explicitly mention data documenting the learning curve. Surprisingly, no study till date has evaluated the learning curve in detail (Mirza et al, 2002;Pandya et al, 2010;Malhotra, 2015;Kashkouli et al, 2003). Ours was a unique study in which we compared the results of external DCR surgery by a trainee ophthalmologist over time.…”

“…This procedure creates an anastomosis between the lacrimal sac and the middle meatus of the nose, bypassing the nasolacrimal duct (Murthy et al, 2012). It is being practiced all around the world, with success rates ranging from 88% to 95% (Watts et al, 2001;Mirza et al, 2002;Besharati et al, 2005;Karim et al, 2011).…”

The Success Rate of Endocanalicular Laser Dacryocystorhinostomy with Two Different Mitomycin-C Application

“…Basically, it is a bypass surgery in which obliterated nasolacrimal duct is bypassed and lacrimal sac is opened directly into the nasal cav- ity. Traditionally this operation is done via an external approach with high success rates (82-99%) [4][5][6][7][8][9][10][11]. In spite of such good results, the procedure has various disadvantages like eksternal skin incision and scar, excessive intra-operative bleeding, disruption of the medial canthus anatomy, long surgical time and high morbidity [12].…”