Korean J Ophthalmol.  2015 Dec;29(6):368-374. 10.3341/kjo.2015.29.6.368.

Surgical Outcomes of Canalicular Trephination Combined with Endoscopic Dacryocystorhinostomy in Patients with Distal or Common Canalicular Obstruction

• Kong YJ
• Choi HS
• Jang JW
• Kim SJ
• Jang SY

• KMID: 2363843
• DOI: http://doi.org/10.3341/kjo.2015.29.6.368

Abstract

PURPOSE
This study investigated the surgical outcomes of canalicular trephination combined with endoscopic dacryocystorhinostomy (DCR) in patients with a distal or common canalicular obstruction. It also identified the factors affecting surgical success rates associated with this technique.
METHODS
We retrospectively reviewed the medical records of 57 patients (59 eyes) in whom a canalicular obstruction was encountered during endoscopic DCR. All patients were treated with endoscopic DCR, followed by canalicular trephination and silicone tube placement. The surgical outcome was categorized as a functional success according to the patient's subjective assessment of symptoms, including epiphora, and as an anatomical success according to a postoperative nasolacrimal duct irrigation test. Surgical success rates were compared based on age, sex, location of the obstruction, number of silicone tubes, and experience of the surgeon.
RESULTS
Functional success was achieved in 55 of 59 eyes (93%) at one month, 50 eyes (84%) at three months, and 46 eyes (78%) at six months. Anatomical success was achieved in 58 of 59 eyes (98%) at one month, 52 eyes (88%) at three months, and 50 eyes (84%) at six months. There was a statistically significant difference in surgical outcome according to the experience of the surgeon. The anatomical success rate at the six-month follow-up exam was 95.4% in the >5 years of experience group, and 53.3% in the <5 years of experience group (p = 0.008, Pearson chi-square test).
CONCLUSIONS
The success rate of canalicular trephination combined with endoscopic DCR in patients with a distal or common canalicular obstruction decreased gradually during the six-month follow-up period. In particular, patients undergoing procedures with experienced surgeons tended to show excellent surgical outcomes at the six-month follow-up exam.

Keyword

Dacryocystorhinostomy; Lacrimal apparatus disease; Trephining

MeSH Terms

Adult
Aged
Dacryocystorhinostomy/*methods
Female
Follow-Up Studies
Humans
Lacrimal Apparatus/*surgery
Lacrimal Duct Obstruction/*therapy
Male
Middle Aged
*Natural Orifice Endoscopic Surgery
Postoperative Complications
Retrospective Studies
Treatment Outcome
Young Adult

Figure

• 

  Fig. 1 Lacrimal trephine. (A) The trephine consisted of a 21-gauge stainless steel hypodermic tube affixed to a plastic luer hub. (B) There is rounded, blunt-tipped stylet that serves to protect the cutting edge during surgery.

• 

  Fig. 2 Success rate according to follow-up period.

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