Comparison of revision surgeries with transcanalicular diode laser and external approaches in cases with failed transcanalicular diode laser dacryocystorhinostomy.

PURPOSE: To compare the success rates of revision surgeries with transcanalicular diode laser (TCDL) and external approaches in cases with failed TCDL dacryocystorhinostomy (DCR).

METHODS: The medical records of the consecutive TCDL DCR surgeries performed for nasolacrimal duct obstruction between October 2009 and March 2013 were reviewed. Cases with the presence of canalicular stenosis, bone deformities, lacrimal sac neoplasms, additional intranasal deformities, dacryolithiasis, history of previous nasolacrimal surgery, and follow up less than 3 months were excluded from the study. Patency to irrigation was obtained in all patients during surgery. Patients with surgical failure during the follow-up period underwent external DCR or TCDL DCR for revision. Data regarding surgical outcomes after primary surgeries and revision surgeries were analyzed.

RESULTS: One hundred seventy-six primary TCDL DCR surgeries were performed on 162 patients. Forty-four (25.0%) surgeries considered failure during follow up. Four patients had canalicular obstruction and were excluded from study. Six patients declined a second intervention. Eighteen patients underwent external DCR and 16 patients underwent repeated TCDL DCR for revision. Success rates of revision surgeries were 94.4% (17/18) with external DCR and 43.8% (7/16) with TCDL DCR. The difference was statistically significant (p = 0.002).

CONCLUSIONS: Revisions with external DCR are recommended for failed TCDL DCR. Revision TCDL DCR should be performed only in patients avoiding facial incision and preferring incision-sparing surgical techniques for revision.