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Primary transcanalicular diode laser-assisted dacryocystorhinostomy: long-term success rates and risk factors for recurrence

Published:November 01, 2022DOI:https://doi.org/10.1016/j.jcjo.2022.10.003

      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.
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      References

        • Swampillai AJ
        • Epiphora McMullan TF.
        Br J Hosp Med (Lond). 2012; 73: C162-C165
        • Nemet AY.
        The etiology of epiphora: a multifactorial issue.
        Semin Ophthalmol. 2016; 31: 275-279
        • Sibley D
        • Norris JH
        • Malhotra R.
        Management and outcomes of patients with epiphora referred to a specialist ophthalmic plastic unit.
        Clin Exp Ophthalmol. 2013; 41: 231-238
        • Tarbet KJ
        • Custer PL.
        External dacryocystorhinostomy: surgical success, patient satisfaction, and economic cost.
        Ophthalmology. 1995; 102: 1065-1070
        • Karim R
        • Ghabrial R
        • Lynch T
        • Tang B.
        A comparison of external and endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal duct obstruction.
        Clin Ophthalmol. 2011; 5: 979-989
        • Yung MW
        • Hardman-Lea S.
        Analysis of the results of surgical endoscopic dacryocystorhinostomy: effect of the level of obstruction.
        Br J Ophthalmol. 2002; 86: 792-794
        • Koch KR
        • Cursiefen C
        • Heindl LM.
        [Transcanalicular laser dacryocystorhinostomy: one-year-experience in the treatment of acquired nasolacrimal duct obstructions].
        Klin Monbl Augenheilkd. 2016; 233: 182-186
        • Koch KR
        • Kühner H
        • Cursiefen C
        • Heindl LM.
        [Significance of transcanalicular laser assisted dacryocystorhinostomy in modern lacrimal drainage surgery].
        Ophthalmologe. 2015; 112: 122-126
        • Akay F
        • Ilhan A
        • Yolcu Ü
        • Gundogan FC
        • Yildirim Y
        • Toyran S.
        Diode laser-assisted transcanalicular dacryocystorhinostomy: the effect of age on the results.
        Arq Bras Oftalmol. 2015; 78: 164-167
        • Athanasiov PA
        • Prabhakaran VC
        • Mannor G
        • Woog JJ
        • Selva D.
        Transcanalicular approach to adult lacrimal duct obstruction: a review of instruments and methods.
        Ophthalmic Surg Lasers Imaging. 2009; 40: 149-159
        • Go Y
        • Park J
        • Kim K
        • Lee S.
        Comparison of nonlaser endoscopic endonasal revision surgery and diode laser transcanalicular revision surgery for failed dacryocystorhinostomy.
        J Craniofac Surg. 2015; 26: 863-866
        • Alañón Fernández FJ
        • Alañón Fernández MA
        • Martínez Fernández A
        • Cárdenas Lara M
        [Transcanalicular dacryocystorhinostomy technique using diode laser].
        Arch Soc Esp Oftalmol. 2004; 79: 325-330
        • Kaynak P
        • Ozturker C
        • Yazgan S
        • et al.
        Transcanalicular diode laser assisted dacryocystorhinostomy in primary acquired nasolacrimal duct obstruction: 2-year follow up.
        Ophthalmic Plast Reconstr Surg. 2014; 30: 28-33
        • Dogan R
        • Meric A
        • Ozsütcü M
        • Yenigun A.
        Diode laser-assisted endoscopic dacryocystorhinostomy: a comparison of three different combinations of adjunctive procedures.
        Eur Arch Otorhinolaryngol. 2013; 270: 2255-2261
        • Welham RA
        • Henderson PH.
        Results of dacryocystorhinostomy analysis of causes for failure.
        Trans Ophthalmol Soc UK. 1973; 93: 601-609
        • Lee J
        • Choi SY
        • Lee H
        • Chang M
        • Park M
        • Baek S.
        The clinical effectiveness of transcanalicular diode laser-assisted revision surgery for failed endoscopic endonasal dacryocystorhinostomy.
        Br J Ophthalmol. 2015; 99: 1130-1133
        • Narioka J
        • Ohashi Y.
        Transcanalicular-endonasal semiconductor diode laser-assisted revision surgery for failed external dacryocystorhinostomy.
        Am J Ophthalmol. 2008; 146: 60-68
        • Huang J
        • Malek J
        • Chin D
        • et al.
        Systematic review and meta-analysis on outcomes for endoscopic versus external dacryocystorhinostomy.
        Orbit. 2014; 33: 81-90
        • Ayintap E
        • Buttanri IB
        • Sadıgov F
        • et al.
        Analysis of age as a possible prognostic factor for transcanalicular multidiode laser dacryocystorhinostomy.
        J Ophthalmol. 2014; 2014913047
        • Erdöl H
        • Akyol N
        • Imamoglu HI
        • Sözen E.
        Long-term follow-up of external dacryocystorhinostomy and the factors affecting its success.
        Orbit. 2005; 24: 99-102
        • Allen K
        • Berlin AJ.
        Dacryocystorhinostomy failure: association with nasolacrimal silicone intubation.
        Ophthalmic Surg. 1989; 20: 486-489
        • Zenk J
        • Karatzanis AD
        • Psychogios G
        • et al.
        Long-term results of endonasal dacryocystorhinostomy.
        Eur Arch Otorhinolaryngol. 2009; 266: 1733-1738
        • Yu B
        • Xia Y
        • Sun JY
        • et al.
        Surgical outcomes in acute dacryocystitis patients undergoing endonasal endoscopic dacryocystorhinostomy with or without silicone tube intubation.
        Int J Ophthalmol. 2021; 14: 844-848
        • Ciftci F
        • Erşanli D
        • Civelek L
        • Baloglu H
        • Karadayi K
        • Güngör A.
        Histopathologic changes in the lacrimal sac of dacryocystorhinostomy patients with and without silicone intubation.
        Ophthalmic Plast Reconstr Surg. 2005; 21: 59-64
        • Pinto C
        • Queirós T
        • Ferreira C.
        Transcanalicular diode laser–assisted dacryocystorhinostomy: success rates and related factors during 3 years of follow-up.
        Semin Ophthalmol. 2021; 36: 501-506
        • Vicinanzo MG
        • McGwin G
        • Boyle M
        • Long JA.
        The consequence of premature silicone stent loss after external dacryocystorhinostomy.
        Ophthalmology. 2008; 115: 1241-1244
        • Charalampidou S
        • Fulcher T.
        Does the timing of silicone tube removal following external dacryocystorhinostomy affect patients’ symptoms?.
        Orbit. 2009; 28: 115-119
        • Drnovsek-Olup B
        • Beltram M.
        Transcanalicular diode laser-assisted dacryocystorhinostomy.
        Indian J Ophthalmol. 2010; 58: 213-217
        • Pison A
        • Fau JL
        • Racy E
        • Fayet B.
        Acquired fistula of the lacrimal sac and laisser-faire approach: Description of the natural history of acquired fistulas between the lacrimal sac and the skin occurring before planned endonasal dacryocystorhinostomy (DCR) and without any treatment of the fistula.
        J Fr Ophtalmol. 2016; 39: 687-690
        • Sadiq SA
        • Ohrlich S
        • Jones NS
        • Downes RN.
        Endonasal laser dacryocystorhinostomy: Medium term results.
        Br J Ophthalmol. 1997; 81: 1089-1092
        • Ressiniotis T
        • Voros GM
        • Kostakis VT
        • Carrie S
        • Neoh C
        Clinical outcome of endonasal KTP laser assisted dacryocystorhinostomy.
        BMC Ophthalmol. 2005; 5: 2
        • Goel R
        • Nagpal S
        • Kumar S
        • Kamal S
        • Dangda S
        • Bodh SA.
        Our experience with transcanalicular laser-assisted endoscopic dacryocystorhinostomy (TCLADCR) in patients of chronic dacryocystitis with deviated nasal septum.
        Int Ophthalmol. 2015; 35: 811-817
        • Nowak R
        • Rekas M
        • Gospodarowicz IN
        • Ali MJ.
        Long-term outcomes of primary transcanalicular laser dacryocystorhinostomy.
        Graefes Arch Clin Exp Ophthalmol. 2021; 259: 2425-2430