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Klin Monbl Augenheilkd 2022; 239(06): 799-803
DOI: 10.1055/a-1720-1752
Klinische Studie

Comparison of Outcomes of External Dacryocystorhinostomy and Transcanalicular Laser-Assisted Dacryocystorhinostomy in Patients with Primary Acquired Nasolacrimal Duct Obstruction

Vergleich der Ergebnisse der externen Dakryozystorhinostomie und der transkanalikulären lasergestützten Dakryozystorhinostomie bei Patienten mit primär erworbener Obstruktion des Tränen-Nasen-Ductus
Demet Mutlu
1   Department of Ophthalmology, Kayseri City Education and Research Hospital, Kayseri, Turkey
,
Nurettin Bayram
1   Department of Ophthalmology, Kayseri City Education and Research Hospital, Kayseri, Turkey
,
Mustafa Kemal Arici
2   Department of Ophthalmology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
,
Ayse Vural Ozec
2   Department of Ophthalmology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
,
Haydar Erdogan
2   Department of Ophthalmology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
,
Mustafa Ilker Toker
2   Department of Ophthalmology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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Abstract

Purpose This study aimed to compare anatomical and functional outcomes of external dacryocystorhinostomy (EX-DCR) and transcanalicular multidiode laser dacryocystorhinostomy (TDL-DCR) in patients with primary acquired nasolacrimal duct obstruction (PANDO).

Methods This study was conducted on 60 eyes of 60 patients with PANDO. The study subjects were randomly divided into two groups. Group 1 included 30 patients who underwent EX-DCR, and group 2 included 30 patients who underwent TDL-DCR. Surgery success rates were determined by patency of the neo-ostium, with free saline flow on irrigation and the absence of epiphora.

Results There were 23 women (76.7%) and 7 men (23.3%) with a mean age of 47.33 ± 12.44 years in group 1, and 18 women (60%) and 12 men (40%) with a mean age of 46.2 ± 19.4 years in group 2. There was no significant difference between groups 1 and 2 with respect to age or gender (p = 0.801, p = 0.267, respectively). The mean duration of symptoms was 3.2 years, ranging from 1.5 to 5 years. The mean postoperative follow-up was 12.3 ± 2.44 months. At the end of the follow-up period, the surgery success rates were 96.7% (29/30 eyes) in group 1, and 90% (27/30 eyes) in group 2. There was no statistical difference in the surgery success rates between groups (p = 0.612).

Conclusion TDL-DCR is a minimally invasive and safe procedure. The lack of bleeding and incision scar and shorter operation time suggest that TDL-DCR can be a good alternative in PANDO patients.

Zusammenfassung

Ziel Diese Studie zielte darauf ab, anatomische und funktionelle Ergebnisse der externen Dakryozystorhinostomie (EX-DCR) und der transkanalikulären Multidiodenlaser-Dakryozystorhinostomie (TDL-DCR) bei Patienten mit primär erworbener Tränennasengangobstruktion (PANDO) zu vergleichen.

Methoden Diese Studie wurde an 60 Augen von 60 Patienten mit PANDO durchgeführt. Die Studienteilnehmer wurden nach dem Zufallsprinzip in 2 Gruppen eingeteilt. Gruppe 1 umfasste 30 Patienten, die sich einer EX-DCR unterzogen, und Gruppe 2 umfasste 30 Patienten, die sich einer TDL-DCR unterzogen. Die Erfolgsraten der Operation wurden durch die Durchgängigkeit des Neoostiums mit dem freien Salzfluss bei Spülung und dem Fehlen von Epiphora bestimmt.

Ergebnisse In Gruppe 1 befanden sich 23 Frauen (76,7%) und 7 Männer (23,3%) mit einem Durchschnittsalter von 47,33 ± 12,44 Jahren, während sich 18 Frauen (60%) und 12 Männer (40%) mit einem Durchschnittsalter von 46,2 ± 19,4 Jahren in Gruppe 2 befanden. Es gab keinen signifikanten Unterschied zwischen den Gruppen 1 und 2 bezüglich Alter und Geschlecht (p = 0,801 bzw. p = 0,267). Die durchschnittliche Dauer der Symptome betrug 3,2 Jahre und reichte von 1,5 bis 5 Jahren. Die mittlere postoperative Nachbeobachtungszeit betrug 12,3 ± 2,44 Monate. Am Ende der Nachbeobachtungszeit lagen die Operationserfolgsraten bei 96,7% (29/30 Augen) in Gruppe 1, während sie bei 90% (27/30 Augen) in Gruppe 2 lagen. Es gab keinen statistischen Unterschied bei den Operationserfolgsraten zwischen den Gruppen (p = 0,612).

Fazit Die TDL-DCR ist ein minimalinvasives und sicheres Verfahren. Das Fehlen von Blutungen und Schnittnarben sowie die kürzere Operationszeit legen nahe, dass die TDL-DCR bei PANDO-Patienten eine gute Alternative sein kann.

Key words

anatomy - orbit - nasolacrimal ducts

Schlüsselwörter

Anatomie - Orbita - Tränenwege


Publication History

Received: 27 July 2021

Accepted: 10 December 2021

Article published online:
18 February 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Maini S, Raghava N, Youngs R. et al. Endoscopic endonasal laser versus endonasal surgical dacryocystorhinostomy for epiphora due to nasolacrimal duct obstruction: prospective, randomised, controlled trial. J Laryngol Otol 2007; 121: 1170-1176
    CrossrefPubMedGoogle Scholar
  • 2 Walker RA, Al-Ghoul A, Conlon MR. Comparison of nonlaser nonendoscopic endonasal dacryocystorhinostomy with external dacryocystorhinostomy. Can J Ophthalmol 2011; 46: 191-195
    CrossrefPubMedGoogle Scholar
  • 3 Heichel J, Struck HG. Tränenwegsstenosen im Erwachsenenalter. Klin Monbl Augenheilkd 2021; 238: 211-230
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Plaza G, Beteré F, Nogueira A. Transcanalicular dacryocystorhinostomy with diode laser: long-term results. Ophthalmic Plast Reconstr Surg 2007; 23: 179-182
    CrossrefPubMedGoogle Scholar
  • 5 Heichel J, Hassan T, Bredehorn-Mayr T. et al. Die externe Dakryozystorhinostomie – eine Analyse des Krankenguts der Universitäts-Augenklinik Halle der Jahre 2000–2011. Klin Monbl Augenheilkd 2016; 233: 29-37
    Google Scholar
  • 6 Karim R, Ghabrial R, Lynch T. et al. A comparison of external and endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal duct obstruction. Clin Ophthalmol 2011; 5: 979-989
    CrossrefPubMedGoogle Scholar
  • 7 Levin PS, StormoGipson DJ. Endocanalicular laser-assisted dacryocystorhinostomy. An anatomic study. Arch Ophthalmol 1992; 110: 1488-1490
    CrossrefPubMedGoogle Scholar
  • 8 Mor JM, Guo Y, Koch KR. et al. Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction. J Vis Exp 2017; 128: 55981
    PubMedGoogle Scholar
  • 9 Boush GA, Lemke BN, Dortzbach RK. Results of endonasal laser-assisted dacryocystorhinostomy. Ophthalmology 1994; 101: 955-959
    CrossrefPubMedGoogle Scholar
  • 10 Narioka J, Ohashi Y. Transcanalicular-endonasal semiconductor diode laser-assisted revision surgery for failed external dacryocystorhinostomy. Am J Ophthalmol 2008; 146: 60-68
    CrossrefPubMedGoogle Scholar
  • 11 Simon GJB, Joseph J, Lee S. et al. External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center. Ophthalmology 2005; 12: 1463-1468
    CrossrefPubMedGoogle Scholar
  • 12 Agarwal S. Endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction. J Laryngol Otol 2009; 123: 1226-1228
    CrossrefPubMedGoogle Scholar
  • 13 Koch KR, Cursiefen C, Heindl LM. Transkanalikuläre Laserdakryozystorhinostomie – 1-Jahres-Erfahrung in der Behandlung infrasakkaler Tränenwegsstenosen. Klin Monbl Augenheilkd 2016; 233: 182-186
    PubMedGoogle Scholar
  • 14 Hong JE, Hatton MP, Leib ML. et al. Endocanalicular laser dacryocystorhinostomy analysis of 118 consecutive surgeries. Ophthalmology 2005; 112: 1629-1633
    CrossrefPubMedGoogle Scholar
  • 15 Cakmak SS, Yildirim M. Use of endocanalicular dacryocystorhinostomy with multidiode laser in children. Int J Pediatr Otorhinolaryngol 2010; 74: 1320-1322
    CrossrefPubMedGoogle Scholar
  • 16 Akay F, Ilhan A, Yolcu Ü. et al. Diode laser-assisted transcanalicular dacryocystorhinostomy: the effect of age on the results. Arq Bras Oftalmol 2015; 78: 164-167
    CrossrefPubMedGoogle Scholar
  • 17 Unlu HH, Toprak B, Aslan A. et al. Comparison of surgical outcomes in primary endoscopic dacryocystorhinostomy with and without silicone intubation. Ann Otol Rhinol Laryngol 2002; 111: 704-709
    CrossrefPubMedGoogle Scholar
  • 18 Yildirim Y, Kar T, Topal T. et al. Comparison of Transcanalicular Multidiode Laser Dacryocystorhinostomy with and without Silicon Tube Intubation. J Ophthalmol 2016; 2016: 6719529
    CrossrefPubMedGoogle Scholar
  • 19 Dirim B, Sendul SY, Demir M. et al. Comparison of Modifications in Flap Anastomosis Patterns and Skin Incision Types for External Dacryocystorhinostomy: Anterior-Only Flap Anastomosis with W Skin Incision versus Anterior and Posterior Flap Anastomosis with Linear Skin Incision. ScientificWorldJournal 2015; 2015: 170841
    CrossrefPubMedGoogle Scholar
  • 20 Derya K, Demirel S, Doganay S. et al. Endoscopic transcanalicular diode laser dacryocystorhinostomy: is it an alternative method to conventional external dacryocystorhinostomy?. Ophthalmic Plast Reconstr Surg 2013; 29: 15-17
    CrossrefPubMedGoogle Scholar
  • 21 Uludag G, Yeniad B, Ceylan E. et al. Outcome comparison between transcanalicular and external dacryocystorhinostomy. Int J Ophthalmol 2015; 8: 353-357
    CrossrefPubMedGoogle Scholar
  • 22 Avgitidou G, Koch KR, Heindl LM. Minimalinvasive Therapie von Tränenwegstenosen. Klin Monbl Augenheilkd 2017; 234: 1183-1195
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Hartikainen J, Antila J, Varpula M. et al. Prospective randomized comparison of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy. Laryngoscope 1998; 108: 1861-1866
    CrossrefPubMedGoogle Scholar