Long-term outcomes in revision powered endoscopic dacryocystorhinostomy

Long-term outcomes of revision dacryocystorhinostomy are less known. The aim of this study was to assess the long-term outcomes of revision powered endoscopic dacryocystorhinostomy (DCR).

Retrospective review of all consecutive revision powered endoscopic DCRs performed over a period of 10 years from 2003 to 2012 were included. All patients completed a minimum of 12 months follow-up following stent removal. Patient records were reviewed for demographic data, type of past surgery, causes of failure, clinical and surgical profiles, adjunctive procedures, complications, and success rates at last follow-up.

Twenty-three revision powered endoscopic DCRs were performed on 18 patients who had failed primary DCR. The mean age at surgery was 61 years (range, 28-84 years). All patients presented with epiphora. Nearly 67% (66.7%; 12/18) were failed endoscopic DCRs and 33.3% (6/18) were failed external DCRs. The most common cause of failure was from cicatricial closure of ostium in 55.5% (10/18) of the cases. Over 44% (44.4%; 8/18) of patients underwent adjunctive endonasal procedures at the time of revision endoscopic DCR. The mean follow-up was 26.4 months (range, 12-66 months). A complication of ostium granuloma in 1 patient was noted, which was successfully managed. At the last follow-up, anatomical success was achieved in 91.3% of the cases and functional success in 86.9%.

Powered endoscopic DCR is a suitable option for revising failed DCRs and offers good long-term results. Meticulous evaluation to identify causative factors of failure and addressing them is crucial for successful outcomes.