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

• Published in: Canadian journal of ophthalmology 2023-04, Vol.58 (2), p.118-124
• Main Authors: Güven, Yusuf Ziya, Akay, Fahrettin
• Format: Article
• Language: English
• Subjects: Aged; Blood Loss, Surgical; Dacryocystorhinostomy; Humans; Lacrimal Duct Obstruction; Laser Therapy; Lasers, Semiconductor - therapeutic use; Nasolacrimal Duct - surgery; Risk Factors; Treatment Outcome
• ISSN: 0008-4182; 1715-3360
• DOI: 10.1016/j.jcjo.2022.10.003

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. 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). 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. 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. La présente étude avait pour objectif d'examiner les taux de réussite à long terme de la dacryocystorhinostomie transcanaliculaire (DCR-TC) avec endolaser, ainsi que les facteurs susceptibles d'influer sur la réussite de l'intervention. Ont été inclus à l’étude 300 patients qui ont subi une DCR-TC unilatérale au service d'ophtalmologie de notre hôpital universitaire entre janvier 2011 et juin 2021. Les sujets ont été répartis en 2 groupes, selon qu'ils avaient subi une récurrence (n = 95) ou non (n = 205). Les 300 patients ont été suivis en moyenne pendant 26,7 ± 7,0 mois (fourchette : 11–33 mois). Le taux global de réussite se chiffrait à ≈68 % (205 sur le