Department of Ophthalmology, Division of Oculoplastic, Orbital and Lacrimal Surgery, Erciyes University Medical Faculty, Kayseri, Turkey.
Rom J Ophthalmol. 2023 Jan-Mar;67(1):14-19. doi: 10.22336/rjo.2023.4.
To report perioperative findings of patients with multiple failed-dacryocystorhinostomy (DCR) and to determine the success rate of revision external (rEx-DCR) performed by a modified technique. Thirty-one eyes of 31 patients (19 women, 12 men) with recurrent dacryocystitis or epiphora following at least one previous failed-DCR were assessed regarding the time from initial surgery to recurrence and revision surgery, type of primary surgery (endoscopic, transcanalicular, Ex-DCR), recurrence number, stent usage and the success rate. Relief of epiphora and positive dye test were established as functional and anatomical successes, respectively. The mean age was 43.0 years (8-78), with a mean follow-up period of 21.4 months (6-46). The mean reoperation number was 1.4 (1-5). The mean time from initial surgery to recurrence was 15.2 months (1-55) and to rEx-DCR, 19.8 months (4-65). Untouched medial canthal ligament was observed in 28 (90.3%), improper rhinostomy location in 26 (83.8%), inadequate osteotomy size in 25 (80.6%), single-anterior-flap-only in 5 (16.1%), membranous ostial scar formation in four (12.5%) and no flap in three (9.6%) patients. The success rate was 93.5%, which was lower than our primary modified Ex-DCR (99.1%). The most common reasons for recurrence were small and unsuitable osteotomy locations with intact medial canthal ligaments. "Double-mucosal flap" approach with an anterior sacco-mucosal complex suspension increases the functional success rate, and stent implantation is not obligatory if canalicular problems or small/ atrophic sacs do not exist. The knowledge of technical strategy and teaching pearls improves the success rates of primary and revision surgeries. DCR = dacryocystorhinostomy, Ex-DCR = external DCR, EE-DCR = endoscopic endonasal DCR, TC-LA-DCR = transcanalicular laser-assisted DCR.
报告多次失败的泪囊鼻腔吻合术（DCR）患者的围手术期发现，并确定改良技术行外路修复术（rEx-DCR）的成功率。对 31 例（19 名女性，12 名男性）至少一次失败的 DCR 后出现复发性泪囊炎或溢泪的患者进行评估，评估内容包括初次手术至复发和修复手术的时间、初次手术类型（内镜、经泪小管、外路 DCR）、复发次数、支架使用情况和成功率。溢泪缓解和染料试验阳性分别确立为功能和解剖成功。患者平均年龄为 43.0 岁（8-78 岁），平均随访时间为 21.4 个月（6-46 个月）。平均再手术次数为 1.4 次（1-5 次）。初次手术至复发的平均时间为 15.2 个月（1-55 个月），至 rEx-DCR 的平均时间为 19.8 个月（4-65 个月）。28 例（90.3%）患者发现内侧泪囊韧带未触及，26 例（83.8%）患者发现泪囊造口位置不当，25 例（80.6%）患者发现截骨大小不足，5 例（16.1%）患者仅存在单一的前瓣，4 例（12.5%）患者发现膜性泪囊口瘢痕形成，3 例（9.6%）患者发现无瓣。成功率为 93.5%，低于我们初次改良的外路 DCR（99.1%）。复发的最常见原因是小而不合适的截骨位置和完整的内侧泪囊韧带。采用“双层黏膜瓣”方法行前囊-黏膜复合体悬吊术可提高功能成功率，如果不存在泪小管问题或小/萎缩的泪囊，则不一定需要支架植入。掌握技术策略和教学要点可提高初次和修复手术的成功率。DCR = 泪囊鼻腔吻合术，Ex-DCR = 外路 DCR，EE-DCR = 内镜经鼻内 DCR，TC-LA-DCR = 经泪小管激光辅助 DCR。
