Outcomes of Endoscopic Powered Revision Dacryocystorhinostomy

Abstract

Objective of this study is to determine the etiology of patients applied with revision endoscopic dacryocystorhinostomy (DCR) and to evaluate the operation results.The patients were retrospectively evaluated in respect of demographic data, the time from primary to revision surgery, revision etiology, the use of bicanalicular silicone nasolacrimal tube (BNLT), the time to postoperative removal of the silicone tube, and the success of the revision surgery.The study included 27 patients applied with revision endoscopic DCR between January 2013 and January 2016. The mean age of the patients was 46.7 ± 11.7 years. The mean time from the first operation to revision surgery was 7.2 ± 6.1 months (range, 1-24 months). During the endoscopic DCR, synechia was observed in 2 (7.4%), granulation tissue in 7 (25.9%), inadequate bone window in 5 (18.52%), and membranous scar around the ostium in 22 (81.4%) patients. More than 1 etiologic problem was determined in 8 patients. During the revision procedure, BNLT was applied to 12 (44.4%) patients. At the final follow-up examination, the complaint of epiphora had completely recovered in 18 (66.6%) patients and there were in 9 (33.3%) patients. The mean time to removal of the BNLT was 1.7 ± 0.57 months (range, 1-3 months).The most common cause of recurrent epiphora in endoscopic DCR was the formation of membranous scar. The use of the mucosal flap technique in primary surgery and the application of BNLT to all patients in revision surgery may increase the functional success rate.

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

“…The success rate of 90% for primary endo‐DCR found in the current study population falls within this range . The reported rates of success for revision endo‐DCR has a greater variability than primary procedures, ranging from 91.3% to 66.6% . The 91.5% rate of success for endo‐DCR in our population of revision endo‐DCR patients is thought to reflect the current upper range of success in revision surgery by experienced lacrimal surgeons.…”

“…1 The reported rates of success for revision endo-DCR has a greater variability than primary procedures, ranging from 91.3% 6 to 66.6%. 4 The 91.5% rate of success for endo-DCR in our population of revision endo-DCR patients is thought to reflect the current upper range of success in revision surgery by experienced lacrimal surgeons. It is of interest to note that the success rate for revision endo-DCR surgery reported from our institution in 1991 was only 75%.…”

“…This concept has been supported by findings showing steroid injections improving ostium patency after endo-DCR. 18 Although early studies with the use of laser technology to perform endo-DCR suggested a potential benefit of this technology, 4 there has since been a trend away from laser usage in DCR surgeries. In the current study population, patients who failed revision endo-DCR were significantly more likely to have had intraoperative laser usage than not during their revision surgery.…”

“…3 Endo-DCR has demonstrated rather high rates of success, in the range of 84% to 92% for primary endo-DCR surgeries 1 and 66.6% to 91.3% for revision endo-DCR surgeries. 4 However, there remains a subset of patients who fail endo-DCR surgeries. Little is known about the determinants of long-term success and failure for endo-DCR.…”

“…The most common indications for endo‐DCR are epiphora and dacryocystitis . Endo‐DCR has demonstrated rather high rates of success, in the range of 84% to 92% for primary endo‐DCR surgeries and 66.6% to 91.3% for revision endo‐DCR surgeries . However, there remains a subset of patients who fail endo‐DCR surgeries.…”