External DCR with 1-week intubation shows good long-term outcomes

This paper reports the 4-year outcomes of uncomplicated external dacryocystorhinostomy (DCR) with a 1-week intubation.

Study design

Seventy lacrimal systems of 67 patients underwent DCR. Stents were removed after 1 week. These patients were followed for 4 years and, at that point, they were queried as to the nature of their symptoms.

Outcomes

After 4 years, 93% of patients reported that they had either no tearing or "seldom" tearing. One patient required additional surgery. Four patients had persistent problems, although the nasolacrimal duct was patent in 2 and 1 declined additional testing. One patient had mucosal adhesions. The overall success rate was 97%.

Limitations

The study relied on subjective assessments of tearing, so it may not capture the true success rate; however, such an approach is likely consistent with the indications for surgery. This approach calls the utility of stents into question, and a prospective study that compares the benefits of a stent (i.e., stent vs. no stent) and the duration of a stent would be helpful.

Clinical significance

This study serves to challenge conventional dogmas regarding the duration of stents, and suggests that a shorter duration may be very efficacious. Given that some patients find stents bothersome and that complications may arise for prolonged indwelling stents, clinicians should feel comfortable with early removal.