J Korean Ophthalmol Soc.  2015 May;56(5):651-655. 10.3341/jkos.2015.56.5.651.

Surgical Outcomes of Endonasal Revision Surgery for Failed DCR According to Number of Silicone Tubes

• Jeon HM
• Ahn DS
• Roh JH

• KMID: 2121160
• DOI: http://doi.org/10.3341/jkos.2015.56.5.651

Abstract

PURPOSE
To evaluate the causes of failed dacryocystorhinostomy (DCR) and the effects of transcanalicular diode laser-assisted endonasal revision surgery according to the number of silicone tubes.
METHODS
Sixty-seven patients (70 eyes) who underwent revision surgery using transcanalicular diode laser for failed primary endonasal DCR at Sungmo Eye Hospital between March 2007 and December 2012 were studied retrospectively. The causes of failed DCR and the time of recurrence were evaluated. The revision surgeries were endoscopic removal of granuloma and membrane and synechiolysis with intubation of 1 or 2 silicone tubes. We compared the results of revision surgery with 1 silicone tube and 2 silicone tube intubations.
RESULTS
Recurrence occurred after a mean duration of 4.6 months following the first DCR. The causes of surgical failure were granuloma (35 eyes), membranous obstruction (23 eyes), synechia (7 eyes), and functional obstruction (5 eyes). We performed revision surgery with 1 silicone tube intubation in 45 eyes (group A) and 2 silicone tube intubations in 25 eyes (group B). The final success rates in groups A and B were 75.6% (34/45) and 84% (21/25), respectively (chi-square test, p = 0.828).
CONCLUSIONS
Transcanalicular diode laser-assisted endonasal revision surgery with 2 silicone tubes is not recommended.

Keyword

Double silicone tube intubation; Endonasal dacryocystorhinostomy; Failed dacryocystorhinostomy; Transcanalicular diode laser-assisted revision surgery

MeSH Terms

Dacryocystorhinostomy
Granuloma
Humans
Intubation
Lasers, Semiconductor
Membranes
Recurrence
Retrospective Studies
Silicones*
Silicones

Reference

References

1. Lee TS, Shin HH, Hwang SJ, Baek SH. The results of revisional surgery for the failed endonasal DCR. J Korean Ophthalmol Soc. 2007; 48:186–92.

2. Yoo JH, Lee H, Shin HH, et al. The effects of transcanalicular diode laser-assisted revision surgery for failed dacryocystorhinostomy. J Korean Ophthalmol Soc. 2012; 53:493–8.

3. Patel BC, Phillips B, McLeish WM, et al. Transcanalicular neo-dymium: YAG laser for revision of dacryocystorhinostomy. Ophthalmology. 1997; 104:1191–7.

4. Paik JS, Cho WK, Yang SW. Bicanalicular double silicone stenting in endoscopic dacryocystorhinostomy with lacrimal trephination in distal or common canalicular obstruction. Eur Arch Otorhinolaryngol. 2012; 269:1605–11.

5. Lee TS, Kim JS, Kim JK. The effect of double silicone tube intubation on surgical outcome of endonasal dacryocystorhinostomy. J Korean Ophthalmol Soc. 2002; 43:2089–94.

6. Watkins LM, Janfaza P, Rubin PA. The evolution of endonasal dacryocystorhinostomy. Surv Ophthalmol. 2003; 48:73–84.

7. Rice DH. Endoscopic intranasal dacryocystorhinostomy results in four patients. Arch Otolaryngol Head Neck Surg. 1990; 116:1061.

8. Derya K, Demirel S, Doganay S, et al. Endoscopic transcanalicular diode laser dacryocystorhinostomy: is it an alternative method to conventional external dacryocystorhinostomy? Ophthal Plast Reconstr Surg. 2013; 29:15–7.

9. Orcutt JC, Hillel A, Weymuller EA Jr. Endoscopic repair of failed dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 1990; 6:197–202.

10. Tsirbas A, Davis G, Wormald PJ. Revision dacryocystorhinostomy: a comparison of endoscopic and external techniques. Am J Rhinol. 2005; 19:322–5.

11. Narioka J, Ohashi Y. Transcanalicular-endonasal semiconductor diode laser-assisted revision surgery for failed external dacryocystorhinostomy. Am J Ophthalmol. 2008; 146:60–8.

12. Konuk O, Kurtulmusoglu M, Knatova Z, Unal M. Unsuccessful lacrimal surgery: causative factors and results of surgical management in a tertiary referral center. Ophthalmologica. 2010; 224:361–6.

13. Ragab SM, Elsherif HS, Shehata EM, et al. Mitomycin C-enhanced revision endoscopic dacryocystorhinostomy: a prospective randomized controlled trial. Otolaryngol Head Neck Surg. 2012; 147:937–42.

14. Ciftci F, Erşanli D, Civelek L, et al. Histopathologic changes in the lacrimal sac of dacryocystorhinostomy patients with and without silicone intubation. Ophthal Plast Reconstr Surg. 2005; 21:59–64.

15. Rosen N, Sharir M, Moverman DC, Rosner M. Dacryocystorhinostomy with silicone tubes: evaluation of 253 cases. Ophthalmic Surg. 1989; 20:115–9.

16. Lee SH, Kim SD, Kim JD. Silicone intubation for nasolacrimal duct obstruction in adult. J Korean Ophthalmol Soc. 1997; 38:185–9.

17. Kim SJ, Kim SD. The surgical results of endonasal DCR with two silicone tubes in common canalicular obstruction. J Korean Ophthalmol Soc. 2007; 48:1170–6.

18. Shin HH, Lee TS, Baek SH. The comparision of surgical results of endonasal dacryocystorhinostomy in childen and adults. J Korean Ophthalmol Soc. 2006; 47:877–82.