Success rate of endonasal DCR appears similar to external approach

This study published in April in the Canadian Journal of Ophthalmology reports the results of a retrospective comparison between the success rate of nonlaser nonendoscopic dacryocystorhinostomy (EN-DCR) and standard external DCR (EX-DCR). The authors found that the two techniques had nearly identical success and complication rates, with EN-DCR having the advantage of a slightly shorter operative time and the added benefit of no external scar. Although retrospective, this study is a very useful addition to the literature because it shows that endonasal DCR using the authors' techniques has the same chance of success as external DCR.

The study included 88 patients who underwent 102 consecutive EN-DCR (56 cases) or EX-DCR (46 cases) procedures performed by a single ophthalmologist between November 1995 and September 2003. Patients were followed for an average of 12.8 months (median, five months; range, 2 to 97 months).

The authors used a retinal light pipe within the canaliculus to localize the position of the nasolacrimal sac within the nasal cavity, and the osteomy was made with a Hardy-Sella punch. In addition, they did not use an endoscopy set-up or powered drills to perform their endonasal DCR, which makes the technique more applicable to outpatient settings with basic instrumentation.

The average duration of surgery was 32.1 minutes for EX-DCR and 23.3 minutes for EN-DCR (P < 0.0001). The authors found that surgical success, which they defined as a lack of symptoms that indicated DCR or normal canalicular irrigation, was achieved in 89.8 percent of EX-DCR and 90.2 percent of EN-DCR cases, which was not statistically significantly different. Three cases of intraoperative bleed requiring nasal packing occurred with EX-DCR and two cases with EN-DCR.

The authors say that the advantages of a nonendoscopic method over an endoscopic method include reduced equipment costs, a faster learning curve and minimal invasion of the nasal cavity. Although EN-DCR may require more postoperative follow-up, they believe that the advantages of the procedure and overall patient satisfaction strongly outweigh this issue. While they did not administer a patient satisfaction survey, their clinical impression demonstrated expeditious postoperative recovery with less swelling, much more comfort and, overall, higher patient satisfaction.