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Christopher Lo, Payal Patel, Carisa Petris, Richard Lisman; Revision of failed external dacyrocystorhinostomy with endoscopic-guided balloon dilation. . Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4758.
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Various approaches to revising primary dacyrocystorhinostomy (DCR) have been presented without consensus on technique. We performed a retrospective, observational study of a single surgeon’s experience that introduces a novel minimally invasive approach to revise failed external DCR that is safe, repeatable and avoids an external scar. The technique requires limited endoscopic manipulation and the surgeon may become proficient without advanced training.
An institutional chart review of a single surgeon’s experience with six patients with recurrent epiphora. All patients were status-post external DCR, and had documented recurrence of epiphora and reflux upon irrigation. Study patients subsequently underwent endoscopic-guided balloon DCR using 3 and 5 mm balloon catheters. Surgical success was defined by a patent surgical ostium demonstrated by absence of subjective epiphora and irrigation of saline through nasolacrimal system at 1 week, 1 month and 3 month visits.
All (100%) patients had subjective epiphora and documented reflux of saline upon irrigation of the nasolacrimal system following an external DCR. Average length of time between primary and revision DCR was 55.2 months. Intraoperative steroid injection around the osteotomy scar was used in 50% of study patients. All six patients completed at least 3-months follow-up. Surgical success was achieved in all secondary endoscopic revisions. All (100%) patients had improvement of epiphora at 1 week, 1 month, and 3 month visits. Five (83.3%) patients described complete resolution of epiphora; one (16.7%) patient described 50% improvement of symptoms. All study patients had patent irrigation of saline through nasolacrimal system at post-operative visits.
Secondary external DCR to revise failed DCR can be surgically challenging, require invasive manipulation, and lead to increased scarring. Although primary endoscopic DCR requires advanced endoscopic expertise, secondary endoscopic-guided balloon DCR can be safely performed without advanced technique, provides direct visualization to ensure surgical accuracy, and avoids additional external incisions. Based on our results, this technique promises to have an excellent success rate and may be readily incorporated into surgical practice.
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