Abstract
The purpose of this study is to compare two dacryocystorhinostomy (DCR) techniques in epiphora treatment. This study is a prospective randomized trial. Twenty-nine patients presenting persistent epiphora due to primary acquired nasolacrimal duct obstruction (PANDO) were included in the study. Two groups each consisting of 15 eyes were formed. Mechanical transnasal endoscopic DCR (MTE-DCR) was applied to the first group, while transcanalicular dacryocystorhinostomy with multidiode laser (TCML-DCR) techniques is employed in the second group. Follow-up is conducted in the first day, first week, and first month of the dacryocystorhinostomy which is followed by 4-month follow-up period, and results were compared using statistical methods. The main outcome measures were the elimination of epiphora and unrestricted flow of irrigated saline to the nose. Seven patients were male, 22 were female, and the mean age was 39.3 ± 12.5 years. Mean follow-up times were 111.3 ± 10.5 months and 93 ± 2.9 months in group 1 and group 2, respectively. Complete resolution is achieved in group 1, whereas failures stemming from canalicular stenosis and fibrosis at osteotomy site are recorded in two cases in group 2. Occlusion occurred in the fifth month in both cases. Thus, long-term success rates were 100% in the first and 86.6% in the second group (P = 0.483). MTE-DCR is a strong substitute for external DCR. Although TCML-DCR shows promising results, it is far away from becoming the gold standard technique in epiphora treatment.
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Data availability
The datasets generated and/or analyzed during the present study are not publicly available (obtained from Gazi University Hospital, Ankara repository) but are available from the corresponding author upon reasonable request.
References
Heichel J, Struck HG, Viestenz A, Glien A, Plontke S (2020) Disorders of the lacrimal apparatus, part 1: anatomy, physiology, diagnostics. Laryngorhinootologie 99(2):112–125
Schargus M, Geerling G (2017) Diagnosis and treatment of the watering eye. HNO 65(1):69–84
Bothra N, Wani RM, Ganguly A, Tripathy D, Rath S (2017) Primary nonendoscopic endonasal versus external dacryocystorhinostomy in nasolacrimal duct obstruction in children. Indian J Ophthalmol 65(10):1004–1007
Jawaheer L, MacEwen CJ, Anijeet D (2017) Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction. Cochrane Database Syst Rev 2:CD007097
Mor JM, Matthaei M, Schrumpf H, Koch KR, Bölke E, Heindl LM (2018) Transcanalicular laser dacryocystorhinostomy for acquired nasolacrimal duct obstruction: an audit of 104 patients. Eur J Med Res 23(1):58
Koch KR, Cursiefen C, Heindl LM (2017) Minimally invasive bypass surgery for nasolacrimal duct obstruction: transcanalicular laser-assisted dacryocystorhinostomy. Ophthalmologe 114(5):416–423
Doğan M, Alizada A, Yavaş GF, Kahveci OK, Bakan O (2018) Laser-assisted dacryocystorhinostomy in nasolacrimal duct obstruction: 5-year follow-up. Int J Ophthalmol 1(10):1616–1620. https://doi.org/10.18240/ijo.2018.10.07
Mourya D, Rijal RK (2017) Transcanalicular laser-assisted dacryocystorhinostomy with diode laser. Orbit 36(6):370–374
Ali MJ, Paulsen F (2020) Human lacrimal drainage system reconstruction, recanalization, and regeneration. Curr Eye Res 45(3):241–252
Toti A (1904) Nuovo metodo conservatore di cura radical delle suppurazioni croniche del sacco lacrimale (dacriocistorinostomia). Clin Mod Firenze 10:385–387
Dupuy-Dutemps MM, Bouguet ET (1920) Preliminary note on a dacryocystorhinostomy process. Ann Ocul (Paris) 157:445–447
Caldwell GW (1893) Two new operations for obstruction of the nasal duct, with preservation of the canaliculi and an incidental description of a new lacrimal probe. N Y Med J 57:581–582
McDonogh M, Meiring JH (1989) Endoscopic transnasal dacryocystorhinostomy. J Laryngol Otol 103(6):585–587
Choi KJ, Jang DW, Abi Hachem R (2018) Endoscopic endonasal approaches to the orbit. Int Ophthalmol Clin 58(2):85–99
Rajak SN, Psaltis AJ (2019) Anatomical considerations in endoscopic lacrimal surgery. Ann Anat 224:28–32
Goel R, Nagpal S, Kumar S, Meher R, Kamal S, Garg S (2017) Transcanalicular laser-assisted dacryocystorhinostomy with endonasal augmentation in primary nasolacrimal duct obstruction: our experience. Ophthalmic Plast Reconstr Surg 33(6):408–412
Stock L, Ungerechts R, Emmerich KH (2019) Recanalization of lacrimal duct stenosis by laserdacryoplasty using a diode laser - comparison of success rates using an erbium : YAG laser. Klin Monatsbl Augenheilkd 236(2):163–168
Avgitidou G, Koch KR, Heindl LM (2017) Minimally invasive therapy of lacrimal drainage system stenosis. Klin Monatsbl Augenheilkd 234(9):1183–1195
Feijó ED, Caixeta JA, de Souza Nery AC, Limongi RM, Matayoshi S (2017) A comparative study of modified transcanalicular diode laser dacryocystorhinostomy versus conventional transcanalicular diode laser dacryocystorhinostomy. Eur Arch Otorhinolaryngol 274(8):3129–3134
Athanasiov PA, Prabhakaran VC, Mannor G, Woog JJ, Selva D (2009) Transcanalicular approach to adult lacrimal duct obstruction: a review of instruments and methods. Ophthalmic Surg Lasers Imaging 40(2):149–159
Schlachter DM, Richani K, Black EH (2016) Diode laser-assisted endocanalicular dacryocystorhinostomy: a prospective study. Ophthalmic Plast Reconstr Surg 32(3):183–186
Coumou AD, Genders SW, Smid TM, Saeed P (2017) Endoscopic dacryocystorhinostomy: long-term experience and outcomes. Acta Ophthalmol 95(1):74–78
Konuk O, Kurtulmusoglu M, Knatova Z, Unal M (2010) Unsuccessful lacrimal surgery: causative factors and results of surgical management in a tertiary referral center. Ophthalmologica 224(6):361–366
Plaza G, Beteré F, Nogueira A (2007) Transcanalicular dacryocystorhinostomy with diode laser: long-term results. Ophthalmic Plast Reconstr Surg 23(3):179–182
At'kova EL, Fedorov AA, Root AO, Krakhovetskiy NN, Yartsev VD, Reyn DA, Reznikova LV (2016) Morphological analysis of reparative process at osteotomy site after endoscopic endonasal dacryocystorhinostomy. Vestn oftalmol 132(6):87–92
Yazici B, Yazici Z (2003) Final nasolacrimal ostium after external dacryocystorhinostomy. Arch Ophthalmol 121(1):76–80
Yoon JM, Nam SW, Woo KI, Kim YD (2018) Transcanalicular diode laser-assisted revision surgery for failed dacryocystorhinostomy with or without distal or common canalicular obstruction. Ophthalmic Plast Reconstr Surg 34(3):291–295
Shkol'nik SF, Shkol'nik GS (2019) Transcanalicular endoscopy of the lacrimal pathways. Vestn oftalmol 135(4):78–82
Ajalloueyan M, Fartookzadeh M, Parhizgar H (2007) Use of laser for dacrocystorhinostomy. Arch Otolaryngol Head Neck Surg 133(4):340–343
Yeniad B, Tuncer S, Kir N, Bilgin LK (2012) Orbital infarction syndrome after transcanalicular dacryocystorhinostomy with diode laser. Ophthalmic Surg Lasers Imaging. https://doi.org/10.3928/15428877-20121018-01
Mor JM, Guo Y, Koch KR, Heindl LM (2017) Transcanalicular diode laser-assisted dacryocystorhinostomy for the treatment of primary acquired nasolacrimal duct obstruction. J Vis Exp 13(128). https://doi.org/10.3791/55981
Emmerich KH, Amin S, Meyer-Rüsenberg HW, Ungerechts R (2017) Microendoscopic minimally invasive techniques in lacrimal surgery. Ophthalmologe 114(5):409–415
Ozsutcu M, Balci O, Tanriverdi C, Demirci G (2017) Efficacy of adjunctive mitomycin C in transcanalicular diode laser dacryocystorhinostomy. Eur Arch Otorhinolaryngol 274(2):873–877
Kar T, Yildirim Y, Topal T, Çolakoğlu K, Ünal MH (2016) Efficacy of adjunctive mitomycin C in transcanalicular diode laser dacryocystorhinostomy in different age groups. Eur J Ophthalmol 26(1):1–5
Meeting presentation and other information
This study is a doctoral dissertation and was presented in 46th Turkish Ophthalmology Society National Congress (17–21 October 2012, Antalya, Turkey) as an oral presentation.
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HTA, OK: study design, critical revision; HTA: data acquisition, interpretation, article writing;
OK: performing surgeries, supervision. All the authors have read and approved the final manuscript.
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This prospectively randomized controlled study received approval from the Gazi University Ethical Committee (IRB#2008–366), and the tenets of the Declaration of Helsinki (2008) were followed.
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Akcam, H.T., Konuk, O. Mechanical transnasal endoscopic dacryocystorhinostomy versus transcanalicular multidiode laser dacryocystorhinostomy: long-term results of a prospective study. Lasers Med Sci 36, 349–356 (2021). https://doi.org/10.1007/s10103-020-03038-7
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DOI: https://doi.org/10.1007/s10103-020-03038-7