Long-term outcomes of primary transcanalicular laser dacryocystorhinostomy

Abstract

Purpose: To assess the long-term outcomes of transcanalicular laser dacryocystorhinostomy in cases of primary acquired nasolacrimal duct obstruction (PANDO).

Methods: Retrospective interventional case series was performed on all patients diagnosed with PANDO and who underwent a primary transcanalicular laser dacryocystorhinostomy from Jan 2014 to June 2016. The procedure was performed using 980 nm diode laser. All the patients additionally underwent intraoperative adjunctive procedures: mitomycin C application and silicone intubation. Patients were followed for up to 3 years after surgery. Anatomical success was defined as patent ostium on irrigation, and functional success was defined as resolution of epiphora. The parameters studied include patient demographics, clinical presentation, type of anesthesia, duration of surgery, laser energy delivered, complications, and anatomical and functional success. The variables influencing the outcomes were assessed. Statistical analysis was performed using the package Statistica (version 10.0, Statsoft, Poland).

Results: A total number of 205 patients were assessed. Of these, 73.17% (150/205) were females. The mean age of patients was 62.92 years. The mean laser energy used was 1060.09 J, and the mean operating time was 22.33 min. Approximately, 95% and 68% of the patients completed 1 year and 3 years of follow-up, respectively. The anatomical and functional success rates dropped significantly beyond the 3 months and 6 months postoperative period and maintained the lower success rates beyond 1-year follow-up for up to 3 years. The anatomical and functional success at the end of 3-year follow-up was 56.12% and 33.81%, respectively. The functional success was not affected by gender (P = 0.132), age (P = 0.956), laser energy (P = 0.626), or duration of the surgery (P = 0.906). However, the intraoperative pain scale was influenced by the laser energy (P < 0.001) and the duration of the surgery (P < 0.001).

Conclusion: The anatomical and functional outcomes of primary transcanalicular laser dacryocystorhinostomy are suboptimal and not encouraging in the long term.

Keywords: DCR; Dacryocystorhinostomy; Lacrimal; Laser; Long-term; Outcomes.