Comparison of endoscopic revision for failed primary external versus endoscopic dacryocystorhinostomy.

BACKGROUND: To compare differences in endoscopic revision after previously failed lacrimal surgery that involved either external or endoscopic dacryocystorhinostomy.

DESIGN:   Retrospective, comparative, nonrandomized clinical study.

PARTICIPANTS: We assessed 77 patients (82 surgeries) treated for recurrent nasolacrimal duct obstruction.

METHODS: Electronic medical records for patients with recurrent epiphora who underwent endoscopic revisional dacryocystorhinostomy, after previous external or endoscopic dacryocystorhinostomy at Seoul St. Mary's Hospital from 2004 to 2010, were reviewed.

MAIN OUTCOME MEASURES: Data regarding the lacrimal drainage system, comprehensive eye examination, surgical outcome and preoperative/perioperative transnasal endoscopy were analysed.

RESULTS: In total, 77 patients underwent 82 endoscopic revisional dacryocystorhinostomy procedures. A success rate of 84% was achieved for cases of previous external dacryocystorhinostomy and 80.7% for previous endoscopic dacryocystorhinostomy (P = 0.722). For preoperative nasal endoscopy, more of the patients who underwent previous external dacryocystorhinostomy exhibited a hypertrophic middle turbinate and severe septal deviation when compared with patients who underwent previous endoscopic dacryocystorhinostomy (P = 0.031, P = 0.001, respectively). For perioperative nasal endoscopy, more of the patients who underwent previous endoscopic DCR exhibited a smaller ostium when compared with patients who underwent previous external dacryocystorhinostomy (P = 0.031).

CONCLUSIONS: The success rate of revisional dacryocystorhinostomy in the previous external dacryocystorhinostomy group was slightly higher than that in the previous endoscopic dacryocystorhinostomy group. Differences in preoperative and perioperative endoscopic findings were detected between the groups. Clarifying these differences in endoscopic revision will help improve the surgical outcomes of primary surgery involving either external or endoscopic dacryocystorhinostomy.