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The goal of this study is to determine if a certain revision DCR approach (external, endoscopic endonasal, laser transcanalicular) is superior to others. Additionally, this investigation evaluates the effect of the primary surgery on success of revision. This investigation is a systematic review and meta-analysis. All studies specifying type of primary DCR and revision DCR were included. Proportion of successes of each revision for every primary surgery was obtained from the included studies. Meta-analyses were performed to determine cumulative proportions of successes across studies. Significant differences in the proportions yielded by meta-analysis of successes among different surgical approaches. The type of primary surgery did not significantly influence overall revision success if the same procedure was used for the revision. Overall successes per each revision type were not significantly different. When performing subgroup analyses per each primary surgery, all methods of revisions were similar in efficacy with one exception: when the primary surgery was done using the laser transcanalicular approach, external revision outperformed repetition of the primary method. Regarding success of re-operation, surgeons can use the method they are most comfortable with to perform DCR revisions. However, primary transcanalicular laser DCRs should be revised, if necessary, using the external approach. [ABSTRACT FROM AUTHOR]

Purpose: Success rates for endoscopic and external dacryocystorhinostomy vary widely (external 70–95%; endonasal 59–99%). We investigated surgical preferences and reported success rates in dacryocystorhinostomy amongst American Society of Ophthalmic Plastic and Reconstructive Surgery members. Methods: This retrospective study utilized a questionnaire sent to American Society of Ophthalmic Plastic and Reconstructive Surgery members. Information culled included number of cases performed, surgical approach, and results. Results: 214 (38% response rate) surveys were completed, representing over 7,054 cases in one year. 93.9% of respondents offer external dacryocystorhinostomy; 63.1% offer endonasal. Surgeons report an increased rate of post-operative tearing with endonasal versus external (35.6% versus 5.8%, p < 0.001) and post-operative dacryocystitis with endonasal versus external (13.2% versus 1.0%, p < 0.001). The top reasons for choosing endoscopic DCR were patient preference, no visible scar, and prior failed DCR. The top reasons for choosing external DCR were higher success rate, physician preference, and more long-term data on outcome. The majority of members use bicanalicular Crawford tubes (76%). Tubes were most commonly removed during post-operative months 2 (34.6%) and 3 (36.4%). Conclusions: Despite papers reporting equivalent success rates between external and endonasal dacryocystorhinostomy, more American Society of Ophthalmic Plastic and Reconstructive Surgery members perform greater numbers of external dacryocystorhinostomy, prefer external dacryocystorhinostomy, and report a higher success rate with this approach. [ABSTRACT FROM AUTHOR]

Background: Definitive treatment of nasolacrimal duct obstruction is with external or endonasal dacryocystorhinostomy (DCR). Recent trials suggest surgical equivalency between techniques. We sought to compare alternative outcomes of DCR techniques in terms of quality of life and cost. Methods : This study was a multicentre prospective nonrandomized case series comparing adult patients treated with external or endonasal DCR. Groups were allocated according to DCR technique. Participation did not affect treatment choice. The Glasgow Benefit Inventory (GBI) was utilized to compare postoperative quality of life, and an activity-based costing (ABC) method used to estimate costs of the two techniques. Surgical data were also collected. A minimum of 3 months follow-up was observed. Results : Seventy-seven patients were included-37 external and 40 endonasal. Both techniques resulted in positive health status change, with mean GBI scores of ++16.1 for external DCR and ++24.1 for endonasal ( p == 0.18). Using an ABC method, the operative costs of external DCR were less than endonasal at $$715.79 AUD and $$932.52 AUD respectively. Conclusions : This trial suggests that external and endonasal DCR produce comparable outcomes in terms of postoperative quality of life, with external DCR resulting in lower operative costs. [ABSTRACT FROM AUTHOR]