The Success Rate of Endonasal Endoscopic Dacryocystorhinostomy in Acquired Nasolacrimal Duct Obstruction

Abstract

Aim: To evaluate the success rate and prognostic factors influencing the endonasal endoscopic dacryocystorhinostomy (DCR) in acquired nasolacrimal duct obstruction. Patients & Methods: Retrospective non comparative study recruited all acquired nasolacrimal duct obstruction case between January 2010 and December 2011. Endonasal endoscopic DCR was performed by one surgeon in all of the case included in the study. Cases that followed less than 3 months after removal of the stent were excluded from the study. Surgical success was defined as both subjective and objective outcome. The Subjective outcome was defined by asking the patients about the symptoms. The objective outcome was defined by irrigation test. Variable factors were assessed including age, gender, underlying disease, intraoperative technique, complication, operative time and postoperative stent removal time. The prognostic factors also were analyzed. Results: All 195 eyes in 131 patients were included in this study with age range of 13 to 89 years old (mean 58.1 years old). They consisted of 122 females (93.1%) and 9 males (6.9%). There were 67 cases with single eye (right 35 cases, Left 32 cases) and 64 cases with both eyes involvement. The mean operation time per eye was 16.7±4.7 minutes (range 7.5 to 40 minutes). The mean bone volume was 0.4±0.2 ml. All cases wee operated under the same technique, the suturing of anterior flap of lacrimal sac. The anterior flap could be could be sutured in 169 eyes (86.7%) and cannot be sutured in 26 eyes (13.3%). The surgical success was achieved in 187 eyes (95.9%). The six of eight eyes in the failure group could not be operated with suturing of the anterior flap. Hence, the suturing of the anterior flap was a statistically significant factor in the outcome of endonasal endoscopic DCR (p-value 0.001). There was no significant difference in preoperative factor, age, gender, side, underling disease, operative time, bone volume removed, complication and postoperative stent removal time (p-value>0.05) There was no serious complication. Conclusion: The successful rate of the endonasal endoscopic DCR is very high (95.9%). The endonasal endoscopic DCR has an advantage as compared with the external DCR, with no scarring and the short recovery time. The suturing of the anterior flap enhances the successful rate of the endonasal endoscopic DCR.