Surgical outcomes of external dacryocystorhinostomy and risk factors for functional failure: a 10-year experience

Lee, MJ; Si, Khwarg; Ih, Kim; Jh, Choi; Choi, Yoon‐Ho; N., Kim; Hk, Choung

doi:10.1038/eye.2016.308

Cited by 36 publications

(33 citation statements)

References 25 publications

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“…Our findings support the assertion that DCR is a more suitable option for management of CCO or canalicular obstruction rather than canalicular trephination or canaliculoplasty, considering the possibility of combined lacrimal sac changes. In terms of success rate of external DCR, the functional success rate was higher in the primary NLDO group than in CCO or canalicular obstruction, in agreement with previous studies [ 5 13 14 ]. In cases of thick CCO, the status of the lacrimal sac affected the functional success rate, and this is a novel finding that has not been previously reported.…”

Section: Discussionsupporting

confidence: 91%

“…The purpose of this study was to classify the locational patterns of lacrimal drainage obstruction and the status of the lacrimal sac in CCO or canalicular obstruction cases based on intraoperative observation during external DCR surgery. Recently, we reported the surgical outcomes of 10 years of external DCR and the risk factors associated with functional failure [ 5 ]. Anatomical success was achieved in 98.8% of cases (760 / 769) and functional success in 81.9% (630 / 769).…”

mentioning

confidence: 99%

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Intraoperatively Observed Lacrimal Obstructive Features and Surgical Outcomes in External Dacryocystorhinostomy

Lee

Khwarg

Kim

et al. 2017

Korean J Ophthalmol

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PurposeTo analyze the features of lacrimal drainage system obstruction confirmed during external dacryocystorhinostomy surgeries and report the surgical outcomes.MethodsWe reviewed the medical records of a total of 769 cases who underwent external dacryocystorhinostomy for primary lacrimal drainage obstruction between 2005 and 2014. Data about detailed location and extent of obstruction were collected intraoperatively. The sites of obstruction were classified into nasolacrimal duct obstruction (NLDO), common canalicular obstruction (CCO), and canalicular obstruction. Lacrimal sac mucosa and lumen were grossly inspected, and the frequency of lacrimal sac changes, such as significant inflammation or fibrosis, was analyzed in cases of CCO or canalicular obstruction. The surgical success rate was also evaluated including effect of lacrimal sac status in the CCO and canalicular obstruction groups.ResultsOf 769 cases, primary NLDO with patent canaliculi was diagnosed intraoperatively in 432 cases (56.2%), CCO in 253 (32.9%), and canalicular obstruction in 84 (10.9%). Of 253 cases with CCO, 122 (48.2%) showed clear lacrimal sac lumen, and the other 131 (51.8%) showed significant inflammation or fibrosis of the lacrimal sac. In cases with canalicular obstruction, 35 of 84 (41.7%) showed a clear lacrimal sac, and the other 49 cases (58.3%) cases revealed mucosal changes of the lacrimal sac. The functional success rate was 87.5% for primary NLDO, 75.5% for CCO, and 72.6% for canalicular obstruction. In the CCO group, the functional success rate was lower in cases with significant lacrimal sac change (p = 0.044).ConclusionsEven in patients with CCO or canalicular obstruction, a large number of cases have lacrimal sac changes, and those changes were associated with lower functional success rate.

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Intraoperatively Observed Lacrimal Obstructive Features and Surgical Outcomes in External Dacryocystorhinostomy

Lee

Khwarg

Kim

et al. 2017

Korean J Ophthalmol

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“…; Lee et al. ) and for the endonasal approach to 84%‐98% (Tsirbas & Wormald ; Tsirbas et al. ; Unlu et al.…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcome of lacrimal stent intubation for complete acquired lacrimal drainage obstructions

Bohman

Kugelberg

Kopp

2019

Acta Ophthalmologica

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Purpose: To investigate long-term outcome and report reoperation rate of noninfected, complete acquired lacrimal drainage obstruction (ALDO) treated with canaliculodacryocystoplasty (CDCP) depending on site of stenosis. Method: Consecutive adult patients with non-infected, complete ALDO treated with CDCP were followed for 76 months. Location of stenosis at preoperative visit and intraoperative probing was recorded, and during follow-up, recurrence of stenosis prompting additional surgery and complications were noted. Survival analysis was applied to compare reoperation rate depending on site of stenosis. A follow-up questionnaire was sent to patients not requiring reoperation asking to grade current epiphora problems. Results: Among 85 included cases (71 patients), 57 were classified as canalicular stenosis and 28 as nasolacrimal duct obstruction (NLDO) preoperatively. At the end of follow-up, 39% (33/85) of cases had required additional surgery due to persistent/recurrent symptoms. No statistical difference was found between these groups.During CDCP, 25 of the 57 preoperatively classified canalicular stenosis were found to have an additional obstruction below the sac. The group with only canalicular stenosis had a statistically significant higher survival compared with cases with NLDO or multiple obstructions (p = 0.03). Of patients responding to the follow-up questionnaire, 11/37 cases experienced epiphora often or constant. Conclusion: Treating complete NLDO with CDCP results in a high reoperation rate and seems an insufficient alternative. Canaliculodacryocystoplasty (CDCP) may be discussed if preoperative examination indicates canalicular stenosis and dacryocystorhinostomy is not desirable. However, the patient needs to be aware of the higher risk for additional surgery, especially if a second stenosis is found during probing.

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“…11 We removed whole sac in long standing dacryocystitis to avoid failure and patient's agony of reoperations. Smaller fibrosed sacs are documented to have high failure risk 12 . Diverse aspects of causes of failed DCR have been reported in literature ranging from cicatricial ostium closure, scarring of common canaliculus, distal canalicular obstruction, granuloma formation and bone neogenesis 16 .…”

Section: Discussionmentioning

confidence: 99%

“…If these sacs are to be left in place they are source of recurrent infections and failed procedure due to insufficient marsupialization 11 . Lee et al has reported small sacs to have a high risk of failure 12 . Endolaser equipment for DCR is expensive, needs more expertise and is not available in our setup.…”

Section: Introductionmentioning

confidence: 99%

External Dacryocystorhinostomy with Intubation in Shrunken Fibrotic Sac in Chronic Dacryocystitis

et al. 2020

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Purpose: To assess anatomical success rate of external dacryocystorhinostomy (DCR) with intubation in long standing chronic dacryocystitis with shrunken fibrotic sac. Secondary objective was to document frequency of intraoperative and postoperative complications of external DCR in such cases. Study Design: Quasi experimental study. Place and Duration of Study: Ophthalmology department, Abbasi Shaheed Hospital, Karachi from January 2015 to December 2017. Material and Methods: Patients with chronic dacryocystitis for 2 years or more, 18 to 60 years old, repeated acute attacks twice or more in past 1 year and fibrotic sacs were included. Canaliculitis, canalicular blocks, punctal agenesis and enlarged sacs were excluded. Surgeries were carried out under general anaesthesia. Fibrotic lacrimal sac was identified and excised, ostium was created in nasal bone and bi canalicular intubation was done. Surgery was labeled successful if patency of the pathway was achieved by syringing at 6 month postoperatively. Results: There were 82 patients, with 59 (72%) females. Mean ages were 32 ± 10.3 years. Left eye was seen in 44 (53.7%) patients. Surgery was successful in 61 (74.3%) patients. Intraoperative bleeding occurred 8 (9.8%) and lacrimal crest was difficult to locate in 6 (7.3%) cases. Postoperatively wound infection and ecchymosis was seen in 8 (9.8%) patients, cheese wiring in 5 (6.1%) and fistula was seen in 2 (2.4%) patients. Cross tabulation was done between gender and successful dacryocystorhinostomy which was statistically not significant (p value 0.71). Conclusion: Dacryocystorhinostomy with intubation has good surgical outcome in long standing chronic dacryocystitis with fibrosed sacs. It has few Intraoperative and postoperative complications but they are manageable.

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Surgical outcomes of external dacryocystorhinostomy and risk factors for functional failure: a 10-year experience

Cited by 36 publications

References 25 publications

Intraoperatively Observed Lacrimal Obstructive Features and Surgical Outcomes in External Dacryocystorhinostomy

Intraoperatively Observed Lacrimal Obstructive Features and Surgical Outcomes in External Dacryocystorhinostomy

Long‐term outcome of lacrimal stent intubation for complete acquired lacrimal drainage obstructions

External Dacryocystorhinostomy with Intubation in Shrunken Fibrotic Sac in Chronic Dacryocystitis

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