Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-24T15:46:43.406Z Has data issue: false hasContentIssue false
  • English
  • Français

Endoscopic endonasal laser versus endonasal surgical dacryocystorhinostomy for epiphora due to nasolacrimal duct obstruction: prospective, randomised, controlled trial

Published online by Cambridge University Press:  29 June 2007

S Maini ,
N Raghava ,
R Youngs ,
K Evans ,
S Trivedi ,
C Foy  and
G Mackintosh
S Maini*
Affiliation:
Department of Otolaryngology, Gloucestershire Royal Hospital, Gloucester, UK
N Raghava
Affiliation:
Department of Otolaryngology, Gloucestershire Royal Hospital, Gloucester, UK
R Youngs
Affiliation:
Department of Otolaryngology, Gloucestershire Royal Hospital, Gloucester, UK
K Evans
Affiliation:
Department of Otolaryngology, Gloucestershire Royal Hospital, Gloucester, UK
S Trivedi
Affiliation:
Department of Otolaryngology, Gloucestershire Royal Hospital, Gloucester, UK
C Foy
Affiliation:
Department of Ophthalmology, Gloucestershire Royal Hospital, Gloucester, UK
G Mackintosh
Affiliation:
Research and Development Support Unit, Gloucestershire Royal Hospital, Gloucester, UK.
*
Address for correspondence: Ms Sangeeta Maini, 10 Charlton Court, London Road, Gloucester GL1 3HQ, UK. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Rhinostomy patency is a problem in all forms of dacryocystorhinostomy. Laser-assisted procedures are potentially fast and result in excellent haemostasis. However, they may induce more fibroblastic activity, resulting in excessive scarring and stenosis of the rhinostomy, compared with non-laser dissection.

Objectives:

The objective of this study was to compare subjective outcomes following dacryocystorhinostomy conducted with endoscopic endonasal laser and with endonasal surgical techniques.

Study design:

Prospective, randomised, controlled trial comparing potassium titanyl phosphate endonasal laser dissection with endonasal surgical techniques, for dacryocystorhinostomy to treat epiphora due to primary, acquired nasolacrimal duct obstruction.

Participants:

One hundred and twenty-six adult patients with chronic epiphora due to primary, acquired nasolacrimal sac or duct obstruction.

Interventions:

Interventions comprised endonasal dacryocystorhinostomy, performed using potassium titanyl phosphate laser or surgical dissection, in order to open the lacrimal sac into the nasal cavity.

Outcome measures:

These were: symptom score and symptom relief of epiphora (at three and 12 months post-procedure); duration and ease of procedure; and duration of hospital stay.

Results:

Sixty patients underwent endonasal laser dacryocystorhinostomy and 66 underwent endonasal surgical dacryocystorhinostomy. Symptomatic success was 82 per cent at three months and 68 per cent at 12 months in the laser group, and 76 per cent at three months and 74 per cent at 12 months in the surgical group. A two-point reduction in the symptom score was associated with symptomatic success at three and 12 months. Eight patients randomised to the laser group required additional instrumentation in order to remove thick bone over the lacrimal sac.

Conclusions:

At three months, endonasal laser dacryocystorhinostomy had better results than endonasal surgical dacryocystorhinostomy. However, at 12 months, the surgical procedure had better results than the laser procedure. There was no statistically significant difference between the two groups at three or 12 months with regard to symptomatic outcome. The ease of procedure (on a scale of zero to 10) was 4.5 for the laser procedure and 4.1 for the surgical procedure. The average times for the procedures were 25 minutes in the laser group and 20 minutes in the surgical group. No statistical difference was found when comparing: symptom score improvement for local anaesthetic vs general anaesthetic; ages over and under 70 years; laterality; or operating surgeon. Change in the symptom score was a useful indicator of symptomatic success.

Keywords

Lacrimal Apparatus DiseasesLaser SurgeryDacryocystorhinostomyEndoscopic Surgical Procedures
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 121 , Issue 12 , December 2007 , pp. 1170 - 1176
Copyright
Copyright © JLO (1984) Limited 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Paul, TO. Medical management of congenital nasolacrimal duct obstruction. J Pediatr Ophthalmol Strabismus 1985;22:68–70CrossRefGoogle ScholarPubMed
2 Toti, A. New conservative method of radical cure of chronic suppuration with lacrimal sac dacryocystorhinostomy [in Italian]. Clinica Moderna Pisa 1904;10:385–7Google Scholar
3 Dupuy-detemps, L, Bourguet, J. Plastic procedure of dacryocystorhinostomy and its results [in French]. Annales d'oculistique 1921;158:241–61Google Scholar
4 McPherson, SD Jr, Egleston, D. Dacryocystorhinostomy. A review of 106 operations. Am J Ophthalmology 1959;47:1575–82Google ScholarPubMed
5 Pico, G. A modified technique of external dacryo-cystorhinostomy: Analysis of re-operations. Am J Ophthalmology 1971;72:679–90CrossRefGoogle Scholar
6 Becker, BB. Dacryocystorhinostomy without flaps. Ophthalmic Surgery 1988;19:419–2Google ScholarPubMed
7 Rosen, N, Sharir, M, Moverman, DC, Rosner, M. Dacryo-cystorhinostomy with silicone tubes. Evaluation of 253 cases. Ophthalmic Surgery 1989;20:115–9Google Scholar
8 Wormald, PJ, Tsirbas, A. Investigation and endoscopic treatment for functional and anatomical obstruction of the NLD. Clin Otolaryngol 2004;29:352–6CrossRefGoogle Scholar
9 Wormald, PJ. Powered endoscopic DCR. Laryngoscope 2002;112:69–72CrossRefGoogle Scholar
10 Metson, R. Endoscopic surgery for lacrimal obstruction. Otolaryngol Head Neck Surg 1991;104:473–9CrossRefGoogle ScholarPubMed
11 Sperkelson, MB, Barberan, MT. Endoscopic DCR; surgical technique and results. Laryngoscope 1996;106:187–9CrossRefGoogle Scholar
12 Woog, JJ, Metson, R, Puliafito, CA. Holmium YAG: endonasal laser dacryo-cystorhinostomy. Am J Ophthalmol 1993;116:1–10CrossRefGoogle Scholar
13 Metson, R, Woog, JJ, Puliafito, CA. Endoscopic laser dacryocysto-rhinostomy Laryngoscope 1994;104:269–74CrossRefGoogle Scholar
14 Boush, GA, Lemke, BN, Dortzbach, RK. Results of endonasal laser assisted dacryocystorhinostomy. Ophthalmology 1994;105:955–9CrossRefGoogle Scholar
15 Mathew, MRK, McGuiness, R, Webb, LA, Murray, SB, Esakowitz, L. Patient satisfaction in our initial experience with endonasal endoscopic non-laser DCR. Orbit 2004;23:77–85CrossRefGoogle Scholar
16 Nussbaumer, M, Schreiber, S, Yung, M. Concomitant nasal procedure in endoscopic DCR. J Laryngol Otol 2004;118:267–9CrossRefGoogle Scholar
17 Sadiq, SA, Hugkulstone, CE, Jones, NS, Downes, RN. Endoscopic holmium YAG laser dacryocystorhinostomy. Eye 1996;10:43–6CrossRefGoogle ScholarPubMed
18 Cokkeser, Y, Evereklioglu, C, Er, H. Comparative external versus endoscopic dacryocystorhinostomy: results in 115 patients (130 eyes). Otolaryngol Head Neck Surg 2000;123:488–91CrossRefGoogle ScholarPubMed
19 Moore, MH, Bentley, CR, Olver, JM. Functional and anatomic results after two types of endoscopic endonasal DCR. Ophthalmology 2002;109:1575–82CrossRefGoogle Scholar
20 Muellner, K, Bodner, E, Mannor, GE, Wolf, G, Hoffmann, T, Luxenberger, W. Endolacrimal laser assisted lacrimal surgery. Br J Opthalmol 2000;84:16–8CrossRefGoogle ScholarPubMed
21 Szubin, L, Papegeorge, A, Sacks, E. Endonasal laser-assisted dacryocystorhinostomy. Am J Rhinol 1999;13:371–4CrossRefGoogle ScholarPubMed
22 Reifler, DM. Results of endoscopic KTP laser-assisted dacryocystorhinostomy. Ophthal Plast Reconstr Surg 1993;9:231–6CrossRefGoogle ScholarPubMed
23 Benger, R. Surgical management of involutional entropion. Aust NZJ Ophthalmol 1995;23:351–3CrossRefGoogle ScholarPubMed
24 Whittet, HB, Shun-Shin, GA, Awdry, P. Functional endoscopic transnasal dacryocystorhinostomy. Eye 1993;7(pt 4):545–9CrossRefGoogle ScholarPubMed
25 Weidenbecher, M, Hosemann, W, Buhr, W. Endoscopic endonasal dacryocystorhinostomy: results in 56 patients. Ann Otal Rhinol Laryngol 1994;103(5pt 1):363–7CrossRefGoogle Scholar
26 Yung, MW, Hardman-Lea, S. Endoscopic inferior dacryocystorhinostomy. Clin Otolaryngol Allied Sci 1998;23:152–7CrossRefGoogle ScholarPubMed
27 Mortimore, S, Banlegy, GY, Lancaster, JL, Karkanevatos, A. Endoscopic dacryocystorhinostomy without silicone stenting. J R Coll Surg Edinb 1999;44:371–3Google ScholarPubMed
28 Unlu, HH, Ozturk, F, Mutlu, C, Iiker, SS, Tarhan, S. Endoscopic dacryocystorhinostomy without stents. Auris Nasus Larynx 2000;27:67–71CrossRefGoogle ScholarPubMed
29 Hartikainen, J, Grenman, R, Puukka, P, Seppa, H. Prospective randomised comparison of endonasal endoscopic DCR and external DCR. Ophthalmology 1998;105:1106–13CrossRefGoogle Scholar
30 Bartley, GB. The pros and cons of laser DCR. Am J Ophthalmol 1994;117:103–6CrossRefGoogle Scholar
31 Hartikainen, J, Antila, J, Varpula, M, Puukka, P, Seppa, H, Grenman, R. Prospective randomized comparison of endonasal endoscopic dacryocystorhinostony and external dacryocystorhinostomy. Laryngoscope 1998;108:1861–6CrossRefGoogle ScholarPubMed
32 Dresner, SC, Klussman, KG, Meyer, DR, Linberg, JV. Outpatient DCR. Ophthalmic Surg 1991;22:222–4Google Scholar
33 Tripathi, A, Lesser, TH, O'Donnell, NP, White, S. Local anaesthetic endonasal endoscopic laser DCR: analysis of patient acceptability and various factors affecting the success of this procedure. Eye 2002;16:146–9CrossRefGoogle ScholarPubMed
34 Rodriguez Navarro, MA, Perez Mareno, JA, Padilla Rodriguez, J, Cantos Gomez, E, Sanz Campillo, J, Marti Ascanio, N. Use of EMLA cream and rupivacaine in DCR with loco regional anaesthesia and sedation [in Spanish]. Revista Española de Anestesiología y Reanimación 2001;48:197–8Google Scholar