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Anne Barmettler, Gary J. Lelli; Incidence Of Post-operative Tearing And Complications After Endoscopic Versus External Approach Dacryocystorhinostomy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):723.
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Dacryocystorhinostomy is the procedure of choice for nasolacrimal duct obstruction and can be performed externally and endoscopically. We investigated the preferences for surgical approach, reasoning behind approach chosen, and reported success amongst American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) members.
A one page questionnaire was sent to ASOPRS members via an online survey service. Responses were tabulated for total number of cases performed, surgical approach preferred, reasons for surgical preferences, incidence of post-operative tearing and dacryocystitis, and surgeon experience level.
Five hundred and fifty-eight ASOPRS members were asked to complete the one page survey, of whom, 214 (38%) responses were received, collectively representing well over 7,054 cases performed in the last year. Among respondents, 205 (95.8%) offer an external DCR option and 9 (4.2%) do not offer an external DCR option. 135 members (63.1%) offer an endoscopic option and 79 (36.9%) do not offer an endoscopic DCR option. A significantly greater proportion of surgeons report <10% rate of post-operative tearing with external DCR (194 of 206 members or 94.2%), compared to endoscopic DCR (87 of 135 members or 64.4%), p<0.001. Also, a significantly greater proportion of surgeons report fewer post-operative complications with external DCR over endoscopic DCR. Surgeons reported < 5% rate of dacryocystitis with external DCR (205 of 207 or 99.0%) compared to endoscopic DCR (119 of 137 or 86.8%) p<0.001. Members performing both surgical approaches tended to perform external DCR, only 29% performed endoscopic DCR’s more than 50% of the time. The top reasons for choosing endoscopic DCR were patient preference, no visible scar, and prior failed DCR. The top reasons for choosing external DCR were higher success rate, physician preference, and more long-term data on outcome. The majority of members use a bicanalicular Crawford tube (76%) and tubes were most commonly removed during postoperative months 2 (34.6%) and 3 (36.4%). There was a good range in years of experience with a slightly greater number of members with greater than 20 years.
Despite multiple recent papers reporting equivalent or higher success rates between external and endoscopic DCR more ASOPRS members responding to this survey perform greater numbers of external DCR’s, prefer external DCR, and report a higher success rate with this approach.
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