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Sung-bok Lee, Kyung Nam Kim, Han Min Lee, Jung Yeul Kim, Seongwook Seo, Hee Bae Ahn, Haeng Jin Lee; The learning curve for endoscopic endonasal dacryorhinostomy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2776.
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To determine the learning curve for endoscopic endonasal dacryorhinostomy (DCR) performed by three surgeons (A, B, C) in three different tertiary hospitals.
The 386 eyes of 337 patients (A: 66 eyes of 60 patients, B: 160 eyes of 144 patients, C: 160 eyes of 133 patients), who underwent endoscopic endonasal dacryorhinostomy for nasolacrimal duct obstruction and were followed up for more than 6 months, were analyzed retrospectively. Success was defined at the final follow-up and the success rate was compared by dividing patients by 20, 30, 40 and 50 eyes to determine the minimum number of surgeries required to stabilize the success rate.
The overall success rate was 86.0%, and each success rate was 83.3% (A), 85.0% (B) and 88.1% (C) (p=0.391). Patients were divided by 20, 30, 40 and 50 eyes for comparison. When patients were divided by 20 eyes, the success rate of surgeon A and C increased after surgeries of 40 eyes (p=0.037, p=0.002). When patients were divided by 30 eyes, the success rates of all three surgeons were significantly increased and maintained after the first 30 surgeries (p=0.020, p=0.037, p=0.024). When patients were divided by 40 eyes, the success rate of surgeon C increased after the first 40 surgeries (p=0.000). When patients were divided by 50 eyes, the success rate of surgeon B and C increased after the first 50 surgeries (p=0.001, p=0.000). After the 30 surgeries, in which the success rate was stabilized, the overall success rate reached 93.6% and each success rate was 94.4% (A), 91.5% (B) and 95.4% (C)(p=0.224).
To achieve high stable DCR success rates, it is believed that at least 30 surgeries would be required.
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