External versus endoscopic dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction
Mohammad Taher Rajabi1, Kianoosh Shahraki1, S Saeed Mohammadi1, Atefeh Nozare1, Zahra Moravej2, Sepideh Tavakolizadeh3, Reza Erfanian Salim3, Farideh Hosseinzadeh4, Shabahang Mohammadi4, Azadeh Farahi3, Kourosh Shahraki5
1 Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Eye, Eye Research Center, School of Medicine, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran
3 Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
4 ENT and Head and Neck Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
5 Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Prof. S Saeed Mohammadi
Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences; Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran
Source of Support: None, Conflict of Interest: None
PURPOSE: The purpose of the study is to compare the surgical outcomes and success rates of external dacryocystorhinostomy (EX-DCR) versus endoscopic endonasal DCR (EN-DCR) for the treatment of primary acquired nasolacrimal duct obstruction (PANDO).
METHODS: This retrospective nonrandomized study was conducted at Farabi Eye Hospital and Noor Eye Hospital, Iran. A review of electronic medical records of all patients with PANDO who underwent EX-DCR or EN-DCR between January 2016 and 2018 was carried out.
RESULTS: A total of 803 patients underwent surgery, of which 618 patients (77%) were managed by EX-DCR and 185 patients (23%) by EN-DCR. The majority of cases (62%) were female. The mean age of the patients in EX-DCR and EN-DCR groups was 40.8 ± 14.2 and 34.3 ± 9.2 years, respectively. EX-DCR resulted in significantly less amount of pain compared to EN-DCR (P < 0.05). The success rate of surgery among EX-DCR and EN-DCR groups was 92.4% and 91.1%, respectively, and did not show statistically significant difference. A higher incidence of intraoperative hemorrhage requiring intervention was noted in the EN-DCR group (16.7% vs. 4.5%). Postoperative patient's satisfaction with EN-DCR and EX-DCR was 73% and 82%, respectively.
CONCLUSION: Both EX-DXR and endoscopic DCR surgeries have high success rates and low incidence of failure. The choice of DCR technique should be based on the experience of the surgeon and patient's lacrimal and nasal anatomy and preferences.