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Vikram Shankar, Krishna Kalyam, Steven M Couch; External Dacryocystorhinostomy: A Comparison of Ultrasonic Bone Aspiration to High Speed Drilling. Invest. Ophthalmol. Vis. Sci. 2018;59(9):101.
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© ARVO (1962-2015); The Authors (2016-present)
Piezosurgical devices offer potential advantages during external dacryocystorhinostomy (DCR) through selectively cutting mineralized bone while minimizing collateral damage to adjacent soft tissue and mucosa. The purpose of this study was to directly compare DCR outcomes using a single piezoelectric device (Sonopet ultrasonic bone aspirator) versus a high-speed electric drill with diamond burr.
An IRB-approved retrospective chart review was conducted on 118 consecutive patients who underwent external DCR by a single oculoplastic surgeon between 2012-2017. All patients were treated using the same surgical approach, and only the tool utilized for the osteotomy differed between the Sonopet ultrasonic bone aspirator (UBA) and electric drill treatment groups. Data collected included baseline patient characteristics, presenting symptoms, operative complications, surgical times, and postoperative symptoms.
One hundred and forty-five primary external DCRs performed on 118 patients were included in this study. 53.8% of cases were performed with the Sonopet UBA and 46.2% with the high-speed drill. Most patients were white (91.5%) and female (67.8%), with a mean age of 56.6 years (range 1.2- 92). Operative time was reduced for cases utilizing the UBA (41.2 minutes) instead of the high-speed drill (46.9 minutes; p=0.03). Overall, 93.1% of patients reported a successful outcome after DCR, defined as symptomatic improvement of epiphora without necessity for revision surgery. There were no significant differences in outcomes between the UBA group (92.3% success rate) and drill group (94.0%; p=0.15). Complete symptom resolution was reported by 74.4% of patients treated with the UBA, compared to 74.6% treated with the high-speed drill (p=1.00). Six patients in the UBA group (7.6%) and four in the drill group (6.0%, p=0.75) experienced persistent nasolacrimal duct obstruction after surgery, requiring endoscopic revision surgery performed by the same surgeon. No intraoperative complications occurred in either group.
The Sonopet ultrasonic bone aspirator offers comparable outcomes and complication rates to more conventional surgical tools for external DCR. Through reducing operative time and preserving delicate mucosa, this device is an appealing option for both novice and experienced surgeons.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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