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Etiologic analysis of 100 anatomically failed dacryocystorhinostomies

Authors Dave TV, Mohammad FA, Ali MJ, Naik MN

Received 27 May 2016

Accepted for publication 21 June 2016

Published 28 July 2016 Volume 2016:10 Pages 1419—1422

DOI https://doi.org/10.2147/OPTH.S113733

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Tarjani Vivek Dave, Faraz Ali Mohammed, Mohammad Javed Ali, Milind N Naik

The Institute of Dacryology, L V Prasad Eye Institute, Hyderabad, India

Background:
The aim of this study was to assess the etiological factors contributing to the failure of a dacryocystorhinostomy (DCR).
Patients and methods:
Retrospective review was performed in 100 consecutive patients who were diagnosed with anatomically failed DCR at presentation to a tertiary care hospital over a 5-year period from 2010 to 2015. Patient records were reviewed for demographic data, type of past surgery, preoperative endoscopic findings, previous use of adjuvants such as intubation and mitomycin C, and intraoperative notes during the re-revision. The potential etiological factors for failure were noted.
Results: Of the 100 patients with failed DCRs, the primary surgery was an external DCR in 73 and endoscopic DCR in 27 patients. Six patients in each group had multiple revisions. The mean ages at presentation in the external and endoscopic groups were 39.41 years and 37.19 years, respectively. All patients presented with epiphora. The most common causes of failure were inadequate osteotomy (69.8% in the external group and 85.1% in the endoscopic group, P=0.19) followed by inadequate or inappropriate sac marsupialization (60.2% in the external group and 77.7% in the endoscopic group, P=0.16) and cicatricial closure of the ostium (50.6% in the external group and 55.5% in the endoscopic group, P=0.83). The least common causes such as ostium granulomas and paradoxical middle turbinate (1.37%, n=1) were noted in the external group only.
Conclusion: Inadequate osteotomy, incomplete sac marsupialization, and cicatricial closure of the ostium were the most common causes of failure and did not significantly differ in the external and endoscopic groups. Meticulous evaluation to identify causative factors for failure and addressing them are crucial for subsequent successful outcomes.

Keywords: failed DCR, etiologies, cicatricial closure, osteotomy, endoscopy

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