Five‐ and 10‐Year Outcomes for Primary Endoscopic Dacryocystorhinostomy: Failure Rate and Risk Factors

Cohen, Oded; Amos, Itai; Halperin, Doron; Bavnik, Yosef; Milstein, Asher; Shoshani, Yochai Z.; Leiba, Hana; Warman, Meir

doi:10.1002/lary.28528

Cited by 14 publications

(19 citation statements)

References 26 publications

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“…2). The reduced slope over the years resembles our results for primary END‐DCR in a previous study 18 and could be explained by the fact that the risk for stenosis is higher in the first few years and decreases over time 40 . The reduction of success rates over time may serve as an important tool while discussing surgery outcomes with the patients.…”

Section: Discussionsupporting

confidence: 80%

“…Although these success rates are similar to previous studies (Table IV), this is the first study to define its cohort by a minimum follow‐up of 5 years. Compared with our data on primary END‐DCR success rates, 18 we found comparable immediate success rates (92.5% for primary vs. 93.3% for revision), yet significantly reduced long‐term success rates (86.3% for primary vs. 68.9% for revision). Primary surgery did not affect surgical success or patient satisfaction of the surgery.…”

Section: Discussionsupporting

confidence: 46%

“…However, long‐term outcomes for the endoscopic approach have not yet been answered 39 . Long‐term follow‐up is critical as success rates were shown to decrease over time 13–15,18 …”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic dacryocystorhinostomy (END‐DCR) has comparable results with external dacryocystorhinostomy (EXT‐DCR), with success rates ranging from 72% to 100% for primary surgery 1,2 and several advantages over the open approach, 3 making it the leading approach today. As for revision END‐DCR, success rates have been reported with a greater variance, ranging between 42% and 94%, 4–12 possibly due to variations in defining surgical success and in the length of the follow‐up period, all of which impact on both primary and revision dacryocystorhinostomy (DCR) surgery success rates 13–18 . Other factors, such as younger age, intraoperative laser usage, intraoperative complications, and the lack of mitomycin use, are also associated with revision END‐DCR failure 19–23 …”

Section: Introductionmentioning

confidence: 99%

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Long‐term Outcomes for Revision Endoscopic Dacryocystorhinostomy—The Effect of the Primary Approach

et al. 2020

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Objectives/Hypothesis Revision endoscopic dacryocystorhinostomy (END‐DCR) is the preferred approach for failed primary surgeries, yet quality data on long‐term outcomes are lacking. This study aimed to evaluate three aspects of revision END‐DCR: 5‐year success rates, patient satisfaction, and the primary surgical approach's possible impact on revision. Methods This retrospective study included all revision END‐DCRs conducted at Kaplan Medical Center between the years 2002 and 2015. For long‐term follow‐up analysis, two subgroups of first and second revision END‐DCRs with a minimum of documented 5‐year follow‐up after surgery were defined. Data were analyzed according to the primary surgical approach. Surgical success was defined by either anatomical (observed patent lacrimal flow) or functional (symptoms cessation) success. Patient satisfaction was measured by a questionnaire. Results After exclusions, a total of 45 eyes from 38 patients who underwent revision END‐DCR surgeries were included in the study. The yearly success rates from immediate to 5 years following the first revision were 93.3%, 75.5%, 71.1%, 68.9%, 68.9%, and 68.9% for the entire cohort, respectively. Immediate and 5‐year success rates following the second revision were 88.8% and 77.8%, respectively. Primary END‐DCR showed favorable 5‐year success rates and patient satisfaction over primary external dacryocystorhinostomy (EXT‐DCR) in both first and second revisions, but this did not reach significance. Conclusions Revision END‐DCR carries an excellent short‐term success rate, which decreases mainly throughout the first 2 years following surgery. Postoperative follow‐up should be maintained within this timeframe. Revision END‐DCR following either primary endoscopic or EXT‐DCR produces comparable surgical outcomes and patient‐reported satisfaction. Level of Evidence 3b Laryngoscope, 131:E682–E688, 2021

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 46%

“…However, long‐term outcomes for the endoscopic approach have not yet been answered 39 . Long‐term follow‐up is critical as success rates were shown to decrease over time 13–15,18 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long‐term Outcomes for Revision Endoscopic Dacryocystorhinostomy—The Effect of the Primary Approach

et al. 2020

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“…These factors may affect the difference in the time for symptom resolution between the very early EnDCR group and the early EnDCR group. Recently, Cohen et al [ 19 ] found that smoking was associated with long-term surgical failure in EnDCR. However, in this study, since the number of smokers was too small for statistical comparison, it was not able to reveal the effects of smoking on the surgical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Optimal Timing for Primary Early Endoscopic Dacryocystorhinostomy in Acute Dacryocystitis

Sung

Kim

Hwang

et al. 2021

JCM

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Purpose: To evaluate the surgical outcomes of primary early endoscopic dacryocystorhinostomy (EnDCR) in acute dacryocystitis (AD) and to determine the optimal timing for surgery. Methods: A retrospective review of medical records was performed on consecutive patients who underwent primary early EnDCR (within 1 week) for AD between May 2010 and June 2020 (AD group) and an age- and gender-matched control group of NLDO patients who underwent EnDCR (non-AD group). The primary outcome measures were the surgical outcomes at the final follow-up examination. The secondary outcome measure was the clinical course of AD patients. Subgroup analysis was performed to determine the optimal timing of surgery by comparing the outcomes of very early EnDCR (within 3 days) and those of early EnDCR (between 4 and 7 days). Results: Forty-one patients were included in the AD group and 82 patients in the non-AD group. The anatomical and functional success rates were 87.8% and 82.9% in the AD group, and 91.5% and 84.1% in the non-AD group, which were not significantly different between the two groups (p = 0.532 and p = 0.863). In the AD group, the mean times for pain relief and resolution of swelling after surgery were 2.4 and 6.5 days after surgery, respectively. In the subgroup analysis according to the timing of surgery, the time for symptom resolution after diagnosis, the length of hospital stays, and the duration of antibiotic treatments were significantly shorter after very early EnDCR (all ps < 0.05), whereas the surgical outcomes were not different between the two groups (p = 1.000). Conclusions: Primary early EnDCR is a safe and effective procedure for the treatment of AD. In particular, very early EnDCR performed within 3 days leads to faster recovery and shortens the course of antibiotic treatment.

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A simple and efficient technique for suturing and knotting during endoscopic dacryocystorhinostomy

Chen

Liu

Jiang³

et al. 2022

Int Ophthalmol

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Purpose This study evaluated the long-term outcomes of endoscopic suturing and knotting-dacryocystorhinostomy (eSK-DCR) without the use of a stent or mitomycin C. Methods A prospective interventional case series was performed on patients with nasolacrimal duct obstruction (NLDO) who underwent eSK-DCR at Zhongshan Ophthalmic Center from October 2019 to December 2019. The surgeon sutured the lacrimal sac mucosa with the nasal mucosa by tying knots under endoscopic DCR. Subject demographics, preoperative data and postoperative data were collected, including clinical presentation, Munk score for epiphora, surgical indications, operation time, duration of knotting, number of knots, endoscopic ostium size, complications, and anatomical and functional success. Anatomic success was defined as patent ostium on lacrimal irrigation, and functional success was defined as subjective improvement in symptoms. Statistical analysis was performed by IBM SPSS software (Version 20.0; SPSS Inc., Chicago, IL, USA). Results A total of 60 patients (71 eyes) underwent pure eSK-DCR. Of these, 95.0% (57/60) were females. The mean age of the patients was 54.7 years. The mean surgical time was 37.60 min, and the average time for each knotting was 2.86 min. Endoscopic evidence found that all patients showed patent ostium and normal healing of the flaps after 4 weeks. The Munk scores dropped significantly at 6 months postoperatively compared to preoperative scores (P < 0.0001). Although 4 patients (7 eyes) were lost to follow-up at the end of the 2-year period, the anatomical and functional success remained stable during the 2-year follow-up period (anatomical, 100%; functional, 87.5%). No serious complications were detected during the follow-up period. Conclusion Pure eSK-DCR is a simple and reliable therapeutic method for the management of NLDO. The surgical outcomes were good and remained stable beyond 6 months postoperatively.

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Five‐ and 10‐Year Outcomes for Primary Endoscopic Dacryocystorhinostomy: Failure Rate and Risk Factors

Cited by 14 publications

References 26 publications

Long‐term Outcomes for Revision Endoscopic Dacryocystorhinostomy—The Effect of the Primary Approach

Long‐term Outcomes for Revision Endoscopic Dacryocystorhinostomy—The Effect of the Primary Approach

Optimal Timing for Primary Early Endoscopic Dacryocystorhinostomy in Acute Dacryocystitis

A simple and efficient technique for suturing and knotting during endoscopic dacryocystorhinostomy

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