Endoscopic ‘cold steel’ versus laser dacryocystorhinostomy: completing the audit cycle

Lester, Shane; Robson, Andrew; Bearn, Michael A.

doi:10.1017/s0022215107001363

Cited by 18 publications

(11 citation statements)

References 11 publications

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“…Our intraoperative complication rates for both primary and revision endo‐DCR were 3%, similar to the 1% rate reported in a systematic review of DCR surgeries . Our rates of postoperative complications (20% for primary endo‐DCR and 25% for revision endo‐DCR) are also commensurate those reported for endo‐DCR by other authors, including rates presented by Durvasula et al (20%) and Lester et al (19%) …”

Section: Discussionsupporting

confidence: 89%

“…1 Our rates of postoperative complications (20% for primary endo-DCR and 25% for revision endo-DCR) are also commensurate those reported for endo-DCR by other authors, including rates presented by Durvasula et al (20%) 21 and Lester et al (19%). 22 There are several limitations to the current study, including the likelihood that some patients who developed recurrent symptoms after endo-DCR sought help from other physicians, including revision endo-DCR, or chose to forego a revision surgery altogether. 13 Such patients would artificially increase our reported success rate for both primary and revision endo-DCR.…”

Section: Discussionmentioning

confidence: 98%

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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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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 98%

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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“…[12][13][14] In our opinion, the fact that endoscopic DCR carries a success rate comparable to the external approach, does not preclude subsequent external DCR for surgical failures, and is preferred by patients 15 suggests it to be preferable as the first-line treatment. Our respondents indicated that they perceived a good success rate with endoscopic DCR but, nevertheless, recognised the higher success rate of the 'gold standard' of external DCR.…”

Section: Discussionmentioning

confidence: 87%

UK survey of the present role of ear, nose and throat surgeons in lacrimal surgery

Al-Shaikh

Javed

Fincham

et al. 2010

annals

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INTRODUCTION The objective of this study was to evaluate the current involvement of ear, nose and throat (ENT) surgeons in lacrimal surgery. SUBJECTS AND METHODS A postal survey was distributed to 796 practicing UK consultant otorhinolaryngologists listed at the drfoster website. RESULTS Overall, 531 questionnaires were returned, giving a response rate of 66.7%. Of these, 108 (20.6%) respondents indicated they were involved in lacrimal surgery. The majority of otolaryngologists seem to work in collaboration with ophthalmologists. In our survey, 98% (106) perform endoscopic dacryocystorhinostomy (DCR). Most respondents believed lacrimal intubation and dilation to have limited success, endoscopic DCR to have moderate success and external DCR to have high success. CONCLUSIONS Lacrimal surgery is carried out in a spirit of collaboration with ophthalmologists rather than competition. Endoscopic DCR is the favoured surgical procedure of otolaryngologists. The perceived success rate for endoscopic DCR reported in this survey coincides with that reported in the literature.

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“…as both used the same population of patients that underwent external DCR but had different populations for the non‐laser endonasal DCR group 7 and the laser endonasal DCR group 13 . We also merged the data of the papers by Lester et al 14 . and Mirza et al 15 .…”

Section: Resultsmentioning

confidence: 99%

Primary external dacryocystorhinostomy versus primary endonasal dacryocystorhinostomy: a review

Lee

Chai

Loon

2010

Clinical Exper Ophthalmology

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This paper aims to compare the efficacy, mean operative time and adverse effects of primary external dacryocystorhinostomy (DCR) versus primary endonasal DCR in treating acquired nasolacrimal duct obstruction. Searches were performed for studies comparing the two procedures. Two reviewers independently extracted data from 14 eligible studies. A random effects model was used to analyse the studies. Outcome measures were defined as patency of the nasolacrimal canal and mean operative time, and adverse effects as cutaneous scarring and bleeding. Both procedures were comparable in efficacy in terms of full success, partial success and anatomic patency. Subgroup analysis showed no significant difference between prospective and retrospective studies as well as between non-laser endonasal DCR versus external DCR and laser endonasal DCR versus external DCR. Endonasal DCR had a significantly shorter mean operative duration, be it laser endonasal DCR (mean difference: 37.65 min, 95% confidence intervals: 3.54-71.75 min, P: 0.03) or non-laser endonasal DCR (mean difference: 19.22 min, 95% confidence intervals: 2.15-36.28 min, P: 0.03). The odds of postoperative bleeding was not significantly different between the two procedures, whereas postoperative cutaneous scarring was unique to external DCR and occurred in 50 out of 402 (12.44%) external DCRs recorded. Endonasal DCR has comparable success rates with external DCR and has a shorter operative time and no cutaneous scar. However, drawbacks include the steep learning curve and higher costs.

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Endoscopic ‘cold steel’ versus laser dacryocystorhinostomy: completing the audit cycle

Cited by 18 publications

References 11 publications

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

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

UK survey of the present role of ear, nose and throat surgeons in lacrimal surgery

Primary external dacryocystorhinostomy versus primary endonasal dacryocystorhinostomy: a review

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