Success rate of external, endonasal, and transcanalicular laser DCR with or without silicone stent intubation for NLD obstruction: a network meta-analysis of randomized controlled trials.

PURPOSE: To define and compare the effectiveness of external dacryocystorhinostomy (EX-DCR), endonasal (EN-DCR), and transcanalicular laser-assisted (TL-DCR) with or without silicone stent (S) intubation. METHODS: Studies were retrieved from PubMed, Scopus, and WoS. Frequentist and Bayesian network meta-analyses were performed and pooled estimations were expressed as risk ratio (RR). We included all original investigations of prospective, randomized controlled trials comparing success rate for any two of the following six surgical procedures: standard EX-DCR with or without S, cold EN-DCR with or without S, and TL-DCR with or without S. The primary outcome measure was the objective success rate. RESULTS: Thirty-two studies with 3277 cases were included in the final quantitative analysis. TL-DCR with S was inferior to EN-DCR with S (RR: 1.20; 95% CI: 1.05-1.37), EX-DCR with S (RR: 1.17 95% CI: 1.05-1.29), EN-DCR without S (RR: 1.18; 95% CI: 1.03-1.35), and EX-DCR without S (RR: 1.15; 95%CI: 1.05-1.26) in frequentist statistics. No other statistical difference was found between other surgeries. When we excluded studies with additional interventions (nasal and revision surgery) for sensitivity analysis, 23 studies with 2468 cases were included to analysis. The success rates of TL-DCR with S and EN-DCR without S became similar (RR: 1.14 95% CI: 0.99-1.30) but there was no change in other outcomes. Similar results were found in Bayesian statistics. The surface under the cumulative ranking curve was higher for EN-DCR with S (0.75), whereas it was higher for EX-DCR with S (0.56) after sensitivity analysis. CONCLUSION: Between endoscopic and external and transcanalicular laser without S procedures, there is no statistical difference. The rank probability showed that EN-DCR with S was a more appropriate surgical option when patients with nasal disease were included, whereas EX-DCR with S was a more appropriate surgical option when patients with nasal disease were excluded from the analysis.

Revision dacryocystorhinostomy: systematic review and meta-analysis.

PURPOSE: The goal of this study is to determine if a certain revision DCR approach (external, endoscopic endonasal, laser transcanalicular) is superior to others. Additionally, this investigation evaluates the effect of the primary surgery on success of revision. METHODS: This investigation is a systematic review and meta-analysis. All studies specifying type of primary DCR and revision DCR were included. Proportion of successes of each revision for every primary surgery was obtained from the included studies. Meta-analyses were performed to determine cumulative proportions of successes across studies. OUTCOME MEASURES: Significant differences in the proportions yielded by meta-analysis of successes among different surgical approaches. RESULTS: The type of primary surgery did not significantly influence overall revision success if the same procedure was used for the revision. Overall successes per each revision type were not significantly different. When performing subgroup analyses per each primary surgery, all methods of revisions were similar in efficacy with one exception: when the primary surgery was done using the laser transcanalicular approach, external revision outperformed repetition of the primary method. CONCLUSIONS: Regarding success of re-operation, surgeons can use the method they are most comfortable with to perform DCR revisions. However, primary transcanalicular laser DCRs should be revised, if necessary, using the external approach.

Optimizing clinical outcomes for endoscopic lacrimal duct recanalization in patients with complete PANDO.

PURPOSE: The study aims to describe modifications and refinements in the technique and technology of Transcanalicular Endoscopic Lacrimal Duct Recanalization (TELDR) based on anatomical foundations to optimize its clinical outcomes in patients with complete Primary Acquired Nasolacrimal Duct Obstruction (PANDO). METHODS: The medical records of 115 patients who underwent TELDR procedures from January 2018 to July 2020 were reviewed retrospectively. Of the 115 patients, only those 35 patients with complete PANDO characterized by longstanding epiphora of 3-5 years duration, dense, diffuse fibrous tissue obstruction involving the sac, sac duct junction and the entire length of the nasolacrimal duct were included in the study. Parameters for success were analyzed based on patency on irrigation, functional endoscopic dye test, and improvement of epiphora. RESULTS: Forty-five cases from 35 patients with complete PANDO were included in the study. The mean length of time from the date of operation to silicone stent removal was 8.1 weeks, while the mean length of follow-up starting from the removal of silicone stent to last follow-up was 61.0 weeks. There were 95.6% anatomic patency on canalicular irrigation with saline and 95.6% functional patency based on functional endoscopic dye test. There was significant improvement of epiphora (p value of < 0.0001) post-operatively. CONCLUSION: The results of modified TELDR improved clinical outcomes and could be a definitive treatment in patients with complete PANDO with longstanding, dense, diffuse, fibrous tissue obstruction. Patients who experience reobstruction, may undergo a repeat of the recanalization approach.

The osteotomy diameter in the transcanalicular laser dacryocystorhinostomy. Our experience in 192 lacrimal pathways.

OBJECTIVES: We want to evaluate the influence of the size of the osteotomy on the postsurgical outcomes. METHODS: A retrospective study was performed in patients who underwent TCL-DCR from January 1, 2008, to March 1, 2019. The patients were divided into two groups: the patients in one group were subjected to LP surgery with an osteotomy diameter equal to 9 mm ± 1 mm (group A), and the patients in the other group were subjected to surgery with an osteotomy diameter equal to 14 mm ± 1 mm (group B). RESULTS: A total of 159 lacrimal pathways (LPs) were operated on in group A with a success rate (SR) of 66.6%. Thirty-three LPs were operated on in group B with an SR of 81.8%. CONCLUSION: An osteotomy diameter equal to 14 mm ± 1 mm achieved better postoperative results than an osteotomy diameter equal to 9 mm ± 1 mm.

Orbital emphysema after transcanalicular laser-assisted dacryocystorhinostomy treated with needle decompression.

Orbital emphysema is an abnormal presence of air in the orbit. It usually arises after blunt trauma or periorbital surgery. When it occurs after dacryocystorhinostomy, usually it is reported as a benign condition. We present a case of a severe orbital emphysema secondary to transcanalicular diode laser-assisted dacryocystorhinostomy. The day after the surgery, the examination revealed crepitant periorbital swelling, general restriction of extraocular motility, visual loss and intraocular pressure of more than 70 mmHg. A computed tomography showed a massive orbital emphysema. An emergency decompression, using a 25-gauge needle attached to an empty syringe lacking a plunger was performed, achieving a quick decrease of intraocular pressure and pain and swelling improvement. Then, in this case, orbital decompression by passive airflow using a needle without a plunger was an effective treatment method to resolve a serious orbital emphysema after transcanalicular laser-assisted dacryocystorhinostomy.

Transcanalicular diode laser assisted dacryocystorhinostomy: A breakthrough in the treatment of acquired nasolacrimal duct obstruction.

OBJECTIVE: To evaluate the success rate of Transcanalicular Diode laser assisted Dacryocystorhinostomy (TC-DCR) in cases of acquired nasolacrimal duct obstruction (NLDO). METHODS: This Quasi-Experimental study was conducted in Armed Forces Institute of Ophthalmology (AFIO) Rawalpindi, from July 2018 to April 2019. In this study, 73 patients of chronic dacryocystitis secondary to acquired NLDO were treated by TC-DCR under general anaesthesia. Follow up examination was done after one day, one week and three months. Silicone tubes were removed three months after surgery and syringing of lacrimal system done to confirm patency of lacrimal passages. Success of the procedure was documented as absence of epiphora and patent nasolacrimal duct on syringing. RESULTS: Seventy three patients (males 27; females 46) were included in this study. Mean age of these patients was 51.6+21 years. On completion of this study which was three months after surgery, we found subjective improvement (absence of epiphora) in 86.3% patients and objective improvement (successful irrigation of lacrimal passages) in 93.2% patients. CONCLUSION: TC- DCR is a minimally invasive technique of doing Dacryocystorhinostomy and imparts more than 90% success rate. It has additional advantages of good cosmetic results, low complication rate and short surgery and convalescence time.

[Transcanalicular endoscopy of the lacrimal pathways]. / Transkanalikuliarnaia éndoskopiia slezootvodiashchikh putei.

PURPOSE: To study the clinical significance of the method of transcanalicular dacryo-endoscopy, and to determine its place in the system of diagnostic and therapeutic measures for obstruction of lacrimal ducts (dacryostenosis). MATERIAL AND METHODS: Transcanalicular endoscopy was performed in 44 patients aged 24 to 65 years with complaints characteristic of dacryostenosis on the equipment manufactured by 'Machida Endoscope Co., Ltd' (Japan). During endoscopy attention was paid to the presence of adhesions, neoplasms, the character of the lacrimal duct contents and its texture (mucus, pus, 'cheesy' masses), resistance to endoscope advancement, physiologically unnatural coloration of the mucosa, vascular picture of the canaliculi walls, sac and nasal duct. RESULTS: Transcanalicular studies revealed the following: complete or partial closure of tear puncta in 3 patients (7%), focal stenosis of the tear ducts - in 6 cases (14%), obstruction at the level of ostium of the lacrimal ducts - 10 cases (23%), tear sac - 2 cases (4%) including due to a neoplasm in its wall, and nasal duct - 12 cases (27%). In 25% of cases (in 11 patients), the tearing disorder was multi-level. CONCLUSION: Transcanalicular endoscopy opens new possibilities for dacryology in terms of the scope and accuracy of topical diagnostics of the obstruction of lacrimal ducts. The proposed and described methods of application of endoscopic techniques provide a more complete picture of the etiology and pathogenesis of diseases of the lacrimal ducts and can increase the effectiveness of their treatment.

Efficacy of adjunctive mitomycin C in transcanalicular diode laser dacryocystorhinostomy.

The objective of the study was to compare the success rate of transcanalicular laser dacryocystorhinostomy (TCL-DCR) with or without the use of adjunctive mitomycin C (MMC) in cases with primary nasolacrimal duct obstruction (NLDO). This retrospective study was comprised of 68 patients with uncomplicated primary NLDO. There were two groups in the study: the Group 1 (n = 35) patients underwent TCL-DCR surgery with MMC and the Group 2 (n = 33) patients underwent TCL-DCR surgery without MMC. All patients had bicanalicular silicone tube intubation. The main outcome measures were patent osteotomy as visualized endoscopically and patent nasolacrimal irrigation. The follow-up period was 12 months. All patients had unilateral TCL-DCR with silicone tube intubation. Six months following surgery, the silicone tubes were removed. At the final evaluation, success rates were 80 % in Group 1 and 78.8 % in Group 2. There was no statistically significant difference between the two groups (p = 0.52). No complications related to MMC usage were recorded during the study period. Intraoperative use of MMC has no beneficial effect on the success rate in TCL-DCR.

Transcanalicular laser-assisted dacryocystorhinostomy with diode laser.

This article compares the efficacy of transcanalicular laser assisted dacryocystorhinostomy (TL DCR) with conventional external dacryocystorhinostomy (Ex DCR). All patients were randomly divided into two groups - Group A included patients who underwent TL DCR and Group B included patients who underwent Ex DCR. 168 operations were done in a total of 163 patients; 79 patients in group A and 84 patients in group B. The overall success rate was 90.12% in group A and 95.40% in group B. The mean total surgical time was 17.41 min in group A and 49.49 min in group B. The duration of stay in hospital was about 3 hours for group A and about 48 hours for group B. Intra and post operative complications were more in group B than in group A. TL DCR can offer a minimally invasive technique with comparable results and better patient satisfaction than Ex DCR.

[The Interdisciplinary Conference on Lacrimal System Disorders of ophthalmic and ENT surgeons at the University Hospital Halle : An analysis of present patient material]. / Die interdisziplinäre Tränenwegskonferenz von Ophthalmo- und Rhinochirurgen am Universitätsklinikum Halle (Saale) : Eine Auswertung des bisherigen Krankenguts.

BACKGROUND AND AIM: The lacrimal system (LS) crosses regions of ocular adnexa, the nose, and the paranasal sinuses. Surgery of disorders requires a targeted ophthalmologic and otolaryngologic examination. Since 2013, an Interdisciplinary Conference on Lacrimal System Disorders (ICLSD) has existed at the University Hospital Halle. First results of our experiences with this cooperation between ophthalmic and ENT surgeons are presented. METHODS: In a retrospective study at the Department of Ophthalmology, University Hospital Halle, all patients aged 22-80 years (n = 43, 10 with bilateral manifestation; mean age 65.1 years) having had a consultation in ICLSD between February 2013 and May 2015 were analyzed. Thereby, 53 LS were included in the descriptive evaluation. RESULTS: The main relevant pathology in terms of ophthalmologic manifestation was chronic dacryocystitis and its complications (n = 42), whereas nasal septum deviation (n = 11) and chronic rhinosinusitis (n = 10) were the most frequent otorhinolaryngologic pathologies. Prior to consultation, ENT (n = 34) and/or ophthalmic surgery (n = 40) had been performed. During ICLSD, an individualized therapeutic regime for each patient was developed. Surgery was required in 43 out of 53 LS. Of these, 32 were mainly ophthalmic, 11 mainly ENT interventions. At the time of evaluation (median 3 months; range 1 to 24 months), 29 out of 38 patients (76.3 %) were free of complaints. CONCLUSION: Since 2013, competences of ophthalmic and ENT surgeons have been integrated in ICLSD for advanced diagnosis and therapy of lacrimal disorders at the University Hospital Halle. Encouraging functional results are shown in this study, as most patients have had a long and complicated history of lacrimal system disorders. ICLSD enables interdisciplinary patient care.

Our experience with transcanalicular laser-assisted endoscopic dacryocystorhinostomy (TCLADCR) in patients of chronic dacryocystitis with deviated nasal septum.

The purpose of this study is to study the operative difficulties and success rate of transcanalicular laser-assisted endoscopic dacryocystorhinostomy in patients of chronic dacryocystitis with deviated nasal septum (DNS). A prospective interventional clinical study of 36 consecutive patients suffering from chronic dacryocystitis with nasolacrimal duct obstruction with DNS undergoing primary TCLADCR from March to June 2011 was carried out. Diode laser was used to create a 16-mm(2) ostium which was enlarged to 64 mm(2) using Blakesley's forceps. Success was defined as anatomical patency and absence of symptoms at 12 months of follow-up. Out of the 36 patients, 25 were females with ages 20-72 years, and 19 were left sided. There were 12 high, 12 mid and 12 basal DNS towards the side of surgery, mild to moderate in severity. Intraoperatively there was difficulty in visualising the aiming beam in the nose, tedious manipulation of endoscope and excessive bleeding in 3 patients. Increased bleeding and failures were significantly higher in high DNS (Fisher exact test-2 tailed: 0.0045). The procedure was successful in 94.4 % cases with average ostium size of 21.94 mm(2) at 12 months and no statistically significant difference in success rates between mild and moderate DNS (Fisher exact test-2 tailed: 1.000). Also there was no difference in the complication rate between mild and moderate DNS (Fisher exact test-2 tailed: 0.0841). TCLADCR is an effective procedure in patients with mild to moderate mid and basal DNS and obviates the need for multiple procedures and a cutaneous scar.

Comparison of transcanalicular diode laser dacryocystorhinostomy and external dacryocystorhinostomy in patients with primary acquired nasolacrimal duct obstruction.

BACKGROUND AND OBJECTIVE: To compare the success, complication, and patient discomfort rates of transcanalicular diode laser dacryocystorhinostomy (TCDL-DCR) and external dacryocystorhinostomy (EX-DCR) surgeries performed in patients with primary acquired nasolacrimal duct obstruction. MATERIALS AND METHODS: Eighty consecutive patients were included in the study, and groups were assigned according to DCR technique. Thirty-four (42.5%) patients received TCDL-DCR (Group A) and 46 (57.5%) patients (Group B) received EX-DCR with temporary silicone stent intubation. The success of surgery was determined by the relief of epiphora, patient satisfaction, endoscopic evaluation of ostium patency, and lacrimal system syringing. Pearson Chi-Square test, Fisher's Exact test, and Student's t-test were used for statistical analyses. RESULTS: Group A included 22 females and 12 males with a mean age of 49.1 ± 15.1 years, Group B included 35 females and 11 males with a mean age of 50.8 ± 11.7 years. There was no difference between groups in terms of age and gender (P = 0.905 and P = 0.167, respectively). The duration of the operation was 22.2 ± 4.8 minutes for Group A, while it was 56.3 ± 15.7 minutes for group B (P = 0.0001). In two patients in Group A, injury in the medial turbinate was recorded, and in Group B, 14 patients experienced mild to severe perioperative bleeding. The perioperative complication rate was significantly different between the groups (P = 0.004). Success in relieving symptoms was 79.4% for Group A and 89.1% for Group B. The difference in the success rates was not statistically significant (P = 0.229). CONCLUSIONS: Although EX-DCR success rate was higher than that achieved with TCDL-DCR, the latter, with its shorter duration of surgery, lower perioperative complication rate, and a similar success rate, may be a good and acceptable surgical alternative in treatment of primary acquired nasolacrimal duct obstruction.

Transcanalicular Diode Laser-Assisted Dacryocystorhinostomy - Success Rates and Related Factors During 3 Years of Follow-Up.

Purpose: To evaluate the success rates of transcanalicular diode laser-assisted dacryocystorhinostomy (TCL-DCR) during 3 years of follow-up and to find clinical factors that influence surgical outcomes.Methods: Major outcomes were the anatomical success defined as a patent neo-ostium tested by irrigation and the functional success defined as a patent osteotomy with the absence of epiphora, accessed at 6-month, 1, 2, and 3-year follow-up visits. To determine which factors influence success rates, patients were divided according to gender, age, previous lacrimal surgeries, nasosinusal anatomy, energy employed, treatment with topical prostaglandin analogs, and timing of extubation.Results: A total of 134 eyes were included. 55.2% of patients underwent peribulbar block. The surgical mean duration was 30.6 min. We obtained anatomical and functional success rates of 80.0% and 70.8% at 6 months; 69.3% and 61.4% at 1 year; 64.2% and 58.0% at 2 years; 56.4% and 46.2% at 3 years, respectively. Functional success was significantly higher in younger patients (p = .008). Bicanalicular intubation for 2 months improved anatomical and functional success rates (p = .028 and p = .001, respectively). No other factors showed a significant impact. 85.8% of patients didn´t experience any complications. Palpebral swelling was the most frequent complication.Conclusion: TCL-DCR is a minimally invasive, repeatable, and safe alternative to treat nasolacrimal duct obstructions. We found success rates comparable to literature and stated that younger patients and those intubated for 2 months show better results.

Anatomical and functional outcomes of transcanalicular diode laser assisted dacryocystorhinostomy as a primary procedure.

INTRODUCTION: The goal of this study was to assess the efficacy of transcanalicular diode laser assisted dacryocystorhinostomy (TDL-DCR) for the treatment of primary acquired nasolacrimal duct obstruction. MATERIAL AND METHODS: This was a single center retrospective study. We included all patients who underwent TDL-DCR between July 2015 and October 2017 for chronic epiphora or chronic dacryocystitis. All procedures were performed under local anesthesia with sedation. The anatomical and functional success rates were studied as a function of each operative indication. RESULTS: Thirty-seven patients were included (18 had chronic epiphora and 19 had chronic dacryocystitis). All but one patient had bicanalicular silicone stent intubation. Irrigation of the lacrimal system demonstrated postoperative patency in 78% of patients operated for chronic epiphora and 76% of those with chronic dacryocystitis. The functional success of the surgery (as defined by the Munk score) was higher if the operative indication was chronic dacryocystitis (62%) (whereas it was only 41% for the indication of chronic epiphora). CONCLUSION: TDL-DCR has a lower anatomical and functional success rate than those reported in the literature for external or endonasal dacryocystorhinostomy. However, it retains a place in the treatment of primary acquired nasolacrimal duct obstruction (in particular when it is complicated by chronic dacryocystitis), especially if there is an absolute or relative contraindication to the two other dacryocystorhinostomy techniques.

Transcanalicular Multidiode Laser Versus External Dacryocystorhinostomy in the Treatment of Acquired Nasolacrimal Duct Obstruction.

OBJECTIVES: This study was a comparison of the outcomes of transcanalicular multidiode laser dacryocystorhinostomy (TCLDCR) and external dacryocystorhinostomy (EXDCR) treatment for patients with acquired nasolacrimal duct obstruction. METHODS: Thirty-one consecutive patients who underwent TCLDCR (TCLDCR group) and 68 consecutive patients who underwent EXDCR (EXDCR group) due to acquired nasolacrimal duct obstruction were enrolled in the study. Follow-up visits were performed on the first day, and at the first week, first month, third month, sixth month, and every six months thereafter. Surgical success was defined as achievement of a patent osteotomy and a successful bicanalicular silicone intubation during the procedure. Anatomical success was defined by observation of a patent osteotomy on lacrimal irrigation, regardless of epiphora. The surgery time and intra- and postoperative complications were noted for each patient. RESULTS: The TCLDCR group had a significantly shorter mean surgery time (27.9±5.5 minutes) compared with the EXDCR group (58.5±12.0 minutes) (p<0.001). However, the mean anatomical and functional rates of TCLDCR (58.0% and 54.8%, respectively) were significantly lower than those of the EXDCR group (94.1% and 91.1%, respectively) (both p<0.001). Two patients had "cheese wiring" damage of the lower canaliculus and 1 patient in the TCLDCR group had a full-thickness skin defect in the medial canthal region. No serious intra- or postoperative complication occurred in the EXDCR group. CONCLUSION: Although a TCLDCR procedure decreased the surgical time, it had a significantly lower success rate in the treatment of acquired nasolacrimal duct obstruction compared to EXDCR. The decision of the type of surgery should be made based on the cosmetic and success expectations of the patients and the presence of systemic problems.

Long-Term Results in Transcanalicular Laser and External Dacryocystorhinostomy.

OBJECTIVES: This study was an examination of the long-term results of transcanalicular laser (TCL) and external (EX) dacryocystorhinostomy (DCR). METHODS: Patients who had undergone TCL-DCR or EX-DCR between 2009 and 2013 were invited for long-term follow-up in 2019. All of the patients who responded had an ophthalmic examination and were assessed using lacrimal irrigation. An intranasal evaluation was performed when the irrigation test had non-patent results. TCL procedures were performed with a diode laser (980 nm). Ostium cleansing with a suction unit and a nasal endoscope was performed in the first week. In EX-DCR procedures, an anterior flap was created and tented to the orbicularis oculi muscle. A silicon tube was implanted in both methods and removed at 4-6 months. RESULTS: A total of 74 EX-DCR patients were assessed. The lacrimal irrigation test was negative in 5 cases. The functional success rate was 93.2% with a follow-up of 8 years. A total of 63 patients who had undergone TCL-DCR were evaluated and the irrigation test was negative in 9 patients. The functional success rate was 85.7% with a follow-up of 7 years. The difference in the success rate was statistically insignificant with a p value of 0.09. CONCLUSION: The long-term success rates of both EX-DCR and TCL-DCR were high.

Transcanalicular laser dacryocystorhinostomy for acquired nasolacrimal duct obstruction: an audit of 104 patients.

PURPOSE: External dacryocystorhinostomy (DCR) is considered as the gold standard in the treatment of acquired nasolacrimal duct obstruction. However, many advances have been made towards the development of modern minimally invasive therapies. These new techniques were proven less harmful to the patients' skin and medial palpebral structures with their palpebral-canalicular pump mechanism. Options include endonasal and transcanalicular procedures. Here, we report on our 2-year experience with the surgical technique, results and complications of transcanalicular laser-assisted DCR. METHODS: This is a retrospective study. A total of 104 patients with acquired nasolacrimal duct obstruction underwent transcanalicular laser-assisted DCR combined with bicanalicular silicon intubation. We then analyzed intra-/post-operative complications and subjective and objective success rates. The institutional ethics committee ruled that approval was not necessary. The trial was registered with the German Clinical Trials Register (DRKS00012879). RESULTS: Transcanalicular laser-assisted DCR in combination with bicanalicular silicon intubation could be performed surgically successfully in 101 patients (97%). In three cases (3%) using the superior canalicular approach, positioning of the laser instrument at the anteroinferior rim of the middle turbinate failed. Complications included thermal injury to the canaliculus (one), canalicular infection (two) and silicon tube prolapse (ten). Functional success (resolution of preoperative symptoms) was achieved in 80 cases (77%), functional failure occured in 24 cases with all patients reporting persisting epiphora, 15 reporting failure to irrigate the nasolacrimal duct and 15 requiring secondary external DCR. CONCLUSIONS: Laser-assisted DCR shows promising results with few complications. It seems well suited as a second-step procedure after failed recanalization and before external DCR.

Functional success evaluation of lacrimal drainage system by dacryoscintigraphy after transcanalicular diode laser dacryocystorhinostomy.

Purpose: The purpose of the study was to evaluate the functional success rates using dacryoscintigraphy (DSG) after transcanalicular diode laser dacryocystorhinostomy (TDL-DCR). Methods: In this retrospective study, we investigated the records of 56 patients who underwent TDL-DCR for unilateral primary acquired nasolacrimal duct obstruction and anatomic patency was achieved. The lacrimal drainage systems of the other eyes of the patients were normal and were selected as control group. The functional success was evaluated with tear transit time (TT) on DSG and epiphora complaints' score (ECS) at postoperative 6 months. Results: Twenty-two (39%) of the patients were male and 34 (61%) were female, with a mean age of 46.6 (21-64). The dacryoscintigraphic findings of the operated and healthy eyes showed that there was statistically insignificant prolongation in the tear TT at the operated side at postoperative 6th month (P > 0.05). The mean ECS of operated eyes was 0.89. Functional success was achieved in 43 (76.8%) patients when the ECS of 0 and 1 was accepted as successful. A statistically significant delay in drainage was observed in DSG in all of the cases with epiphora score of 2 and 3 (P < 0.05). The tear TT was prolonged with the age increase (P < 0.05), but there was no significant difference concerning the gender. Conclusion: DSG is an effective tool to evaluate the functional success of TDL-DCR.

Comparison of outcomes of conventional transcanalicular laser dacryocystorhinostomy and modified transcanalicular laser dacryocystorhinostomy.

INTRODUCTION: Transcanalicular laser DCR (TL-DCR) approaches have been developed for the formation of a fistula between the nasal cavity and the lacrimal sac to ensure the continuity of the lacrimal drainage system over the years. However, the success rate of TL-DCR has varied widely. AIM: To evaluate and compare the success rates of conventional transcanalicular multidiode laser dacryocystorhinostomy and modified transcanalicular multidiode laser dacryocystorhinostomy. MATERIAL AND METHODS: Ninety-one eyes of 91 adult patients admitted with epiphora and diagnosed with chronic dacryocystitis were included in the study. The participants were divided into two groups. Group 1 consisted of 55 patients who were treated with conventional transcanalicular laser dacryocystorhinostomy. Group 2 consisted of 36 patients to whom the same surgical procedure was applied with the difference of nasal mucosa excision prior to laser osteotomy. The groups' intraoperative surgical ostium size, perioperative and postoperative complications, operative times and success rates were compared. RESULTS: The mean follow-up periods for each group were 8.88 ±2.99 months and 10.28 ±4.47 months, respectively (p = 0.077). Intraoperative mean surgical ostium sizes were 31.85 ±14.98 mm2 and 42.25 ±18.09 mm2, respectively (p = 0.004). The mean operation time in group 1 was significantly shorter compared to group 2 (18.55 ±4.05 min and 24.44 ±3.18 min, respectively, p = 0.0001). The overall success rate was 65.45% in group 1 and 75.00% in group 2 (p = 0.335). CONCLUSIONS: Although the surgical ostium area was significantly greater in group 2, there was no significant difference in surgical success and patient satisfaction rates between the two groups.

[Prognostic value of lacrimal duct diagnostics after tube removal : Retrospective analysis of risk of relapse during the first postoperative year after transcanalicular lacrimal duct surgery with silicone tubing]. / Prognostische Aussagekraft der Tränenwegsdiagnostik nach Intubatentfernung : Retrospektive Analyse des Rezidivrisikos im ersten postoperativen Jahr nach transkanalikulärer Tränenwegschirurgie mit Silikonschlauchintubation.

BACKGROUND: Transcanalicular lacrimal duct surgery has become more important over the past two decades. OBJECTIVES: The aim of the study was to prove the prognostic value of postoperative lacrimal syringing and the testing of spontaneous drainage of lacrimal fluid immediately after tube removal. METHODS: A total of 110 cases with postoperative lacrimal syringing and 183 cases with verification of the postoperative lacrimal fluid drainage performed between January 2001 and August 2008 were retrospectively evaluated. The indication for postoperative diagnostics was set by the investigator. The prognostic value of these two procedures was determined by using prognostic parameters (positive predictive value, PPV; negative predictive value, NPV) and analyzing recurrence nonexistence via Cox regression and Kaplan-Meier estimator. The observation period was limited to 12 months. Predominantly, recurrence was defined on the patient's satisfaction and absence of symptoms, which was determined with the help of a questionnaire. RESULTS: Postoperative verification of the lacrimal syringing is a suitable instrument to estimate surgical success within the first year after lacrimal surgery with a PPV of 92.31%. Testing of the spontaneous drainage of lacrimal fluid after tube removal reached a PPV of 63.33%. CONCLUSION: The proven prognostic value shows that syringing of the lacrimal duct and verification of spontaneous drainage should be integrated into postoperative care in a standardized manner. Hereby, early information for the patient about the expected result of the surgical procedure is enabled.