The return of the jedi: comparison of the outcomes of endolaser dacryocystorhinostomy and endonasal dacryocystorhinostomy

Abstract

External dacryocystorhinostomy (DCR) is considered to be the gold standard treatment of primary acquired nasolacrimal duct obstruction. A better understanding of the endoscopic anatomy of the lacrimal sac has increased the success rate of endonasal DCR. Laser DCR has become popular in recent years and has a success rate comparable with those of other endonasal techniques. The aim of this study was to compare the surgical results of endonasal DCR (EDCR) and endonasal laser DCR (ELDCR). Fifty-four patients treated with ELDCR and 42 patients treated with EDCR for nasolacrimal duct obstruction from 2009 to 2012 with at least 1.5 years of follow-up were retrospectively enrolled in this comparative study. Lack of patient complaints and irrigation testing were used as subjective and objective assessment tools, respectively. Both groups were similar in terms of age and sex. ELDCR had a success rate of 85.2%, and EDCR had a success rate of 92.9%. The difference between the 2 procedures was not statistically significant. ELDCR had a significantly shorter operative time than did EDCR (16.9 vs 24.4 minutes, respectively; p < 0.001). Endonasal procedures have the advantage of no scar formation and do not disturb the pumping mechanism of the lacrimal sac. Their success rates are comparable with those of external DCR. Surgery is quicker, and with use of a laser, even less time is spent in the operating room. In selected cases, ELDCR can be a good alternative method with a high success rate.