Powered endoscopic dacryocystorhinostomy

Abstract

Objectives: To describe powered endoscopic dacryocystorhinostomy (DCR) with full sac exposure and primary mucosal anastomosis and report perioperative and follow-up results achieved with this procedure.

Study design: Prospective, nonrandomized cohort study.

Methods: Operative and postoperative data were prospectively collected on 36 unselected patients (15 men and 21 women; mean age, 62.4 y; range 14-91 y) who presented to a lacrimal clinic with epiphora and obstruction of the drainage of the nasolacrimal system and who consecutively underwent either primary or revision powered endoscopic DCR. A total of 47 procedures were performed; all were done by the same surgeon, who used a standardized surgical technique. Follow-up evaluations included symptom evaluation and endoscopic assessment of the newly created ostium with fluorescein testing at each postoperative visit.

Results: The only surgical complication was one case of orbital fat exposure. Forty-five of the 47 DCRs were patent after a mean follow-up of 11 months (standard deviation = 5 mo), yielding a success rate of 95.7%. Patency was assessed by endoscopic visualization of the ostium and fluorescein (initially placed on the conjunctiva) in the ostium. One of the 47 DCRs was a failure and one patient had O'Donaghue tubes in place with symptoms. Two patients with a patent ostium and positive results on fluorescein testing continued to have some symptoms.

Conclusion: Powered endoscopic DCR with full sac exposure and primary mucosal apposition has a success rate comparable to that achieved with external DCR.