Abstract
Objective
The aim of the study was to investigate the long-term success rates of transcanalicular
endolaser dacryocystorhinostomy (TC-DCR) surgery along with the factors that possibly
affect surgical success.
Methods
Patients (n = 300) who underwent unilateral TC-DCR operations in the department of
ophthalmology of our university hospital between January 2011 and June 2021 were included
in the study. The subjects were divided into 2 groups, with group 1 showing no recurrence
(n = 205) and group 2 showing recurrence (n = 95).
Results
The mean follow-up period for the 300 patients was 26.7 ± 7.0 months (range, 11–33
months). The overall success rate was 205 of 300 (∼68%). Although, based on the univariate
risk analysis, age, operative time, total laser power, tube removal time, septum deviation,
fistulisation, and intraoperative hemorrhage were found to be risk factors, in multivariate
risk analysis, only total laser power, septum deviation, and intraoperative bleeding
were determined to be the main risk factors.
Conclusion
The success rate of TC-DCR was lower than that of traditional external DCR, but because
TC-DCR is a minimally invasive aesthetic surgery with a short operative time, it may
become a preferred option by more ophthalmologists, especially for young patients
without intranasal pathology and coagulation disorders and elderly patients at risk
for general anaesthesia. It should be taken into account that the chances of success
are relatively lower among patients with total laser power applied during surgery,
intraoperative hemorrhage, fistulization, and septum deviation. In TC-DCR, bleeding
control, short operative time, and low laser power are important to achieve a high
success rate. Also, 1 year after TC-DCR, even the presence of anatomic drainage may
lower the functional success of patients, so follow-up should be continued.
Résumé
Objectif
La présente étude avait pour objectif d'examiner les taux de réussite à long terme
de la dacryocystorhinostomie transcanaliculaire (DCR-TC) avec endolaser, ainsi que
les facteurs susceptibles d'influer sur la réussite de l'intervention.
Méthodes
Ont été inclus à l’étude 300 patients qui ont subi une DCR-TC unilatérale au service
d'ophtalmologie de notre hôpital universitaire entre janvier 2011 et juin 2021. Les
sujets ont été répartis en 2 groupes, selon qu'ils avaient subi une récurrence (n = 95)
ou non (n = 205).
Résultats
Les 300 patients ont été suivis en moyenne pendant 26,7 ± 7,0 mois (fourchette : 11–33
mois). Le taux global de réussite se chiffrait à ≈68 % (205 sur les 300 patients).
Bien que l’âge, la durée de l'intervention, la puissance totale du laser, le délai
avant le retrait du tube de drainage, la déviation de la cloison nasale, la fistulisation
et l'hémorragie intraopératoire aient été considérés comme des facteurs de risque
lors de l'analyse univariée du risque, seules la puissance totale du laser, la déviation
de la cloison nasale et l'hémorragie intraopératoire ont été considérées comme les
principaux facteurs de risque lors de l'analyse multivariée du risque.
Conclusion
Le taux de réussite de la DCR-TC était moindre que celui de la DCR par voie externe
classique. Par contre, comme la DCR-TC est une intervention micro-invasive et constitue
en fait une chirurgie esthétique de courte durée, elle peut devenir une option de
prédilection pour un plus grand nombre d'ophtalmologistes, surtout s'il s'agit d'un
patient jeune, sans atteinte intranasale ni trouble de la coagulation, ou d'un patient
âgé chez lequel l'anesthésie générale pose un risque. Il est à noter que le taux de
réussite est relativement plus faible lorsque la puissance totale du laser a dû être
utilisée pendant l'intervention, en cas d'hémorragie intraopératoire ou de fistulisation,
et en présence d'une déviation de la cloison nasale. Dans le cadre d'une DCR-TC, la
prise en charge des hémorragies, la courte durée de l'intervention et l'utilisation
d'une faible puissance du laser sont des facteurs importants pour obtenir un taux
élevé de réussite. Enfin, comme la seule présence d'un drainage anatomique risque
de diminuer la réussite fonctionnelle après la DCR-TC, il importe de prolonger le
suivi au-delà de 1 an.
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Article info
Publication history
Published online: November 01, 2022
Accepted:
October 2,
2022
Received in revised form:
September 17,
2022
Received:
August 22,
2022
Identification
Copyright
© 2022 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
