Trends and Outcomes of Endoscopic Versus External Dacryocystorhinostomy: A 20-year Retrospective Multi-Institutional Analysis.

IF 1.3 4区医学 Q3 OPHTHALMOLOGY

Ophthalmic Plastic and Reconstructive Surgery Pub Date : 2025-08-27 DOI:10.1097/IOP.0000000000003049

Natalia Davila, Samantha A McLaughlin, Tejus Pradeep, Brian Wong, Wendy W Lee

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引用次数: 0

Abstract

Purpose: To evaluate 20-year multi-institutional trends in endoscopic dacryocystorhinostomy (EN-DCR) versus external dacryocystorhinostomy (EX-DCR) for acquired nasolacrimal duct obstruction, including comparative long-term revision rates.

Methods: A retrospective cohort study was performed using the TriNetX federated research network. Annual surgical volumes and revision rates at 1, 10, and 20 years were analyzed for patients undergoing EN-DCR or EX-DCR. Propensity-score matching controlled for demographic and clinical characteristics. Joinpoint regression identified trends and significant shifts in procedural rates over time, expressed as annual percent change (APC) for specific intervals and average APC overall.

Results: A total of 14,135 DCR procedures (9,948 EX-DCR, 4,187 EN-DCR) were performed on 12,623 patients. Over the study period, EX-DCR decreased from 87.1% to 60.0% (average APC, -1.9%; p < 0.05), with a greater decline noted after 2018 (APC, -3.9%; p < 0.01). Conversely, EN-DCR increased from 12.9% to 40.1% (overall average APC, +4.9%; p = 0.08), showing significant growth after 2012 (APC, +4.4%; p < 0.01). Surgical revision rates were similar at 1 (EX-DCR 9.0% vs. EN-DCR 8.6%, risk ratios = 1.04, p = 0.61), 10 (EX-DCR 14.5% vs. EN-DCR 13.6%, risk ratios = 1.06, p = 0.31), and 20 years (EX-DCR 14.7% vs. EN-DCR 13.7%, risk ratios = 1.07, p = 0.25). Overall success rates, defined as no surgical revision, were between 85.3% and 91.4% for both approaches.

Conclusion: Over the past 20 years, endoscopic DCR has gained popularity, with steadily increasing use and comparable revision rates to external DCR.

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内窥镜与外部泪囊鼻腔造口术的趋势和结果：20年回顾性多机构分析。

目的：评估20年来多机构在内窥镜下泪囊鼻腔造口术（EN-DCR）和外部泪囊鼻腔造口术（EX-DCR）治疗获得性鼻泪管阻塞的趋势，包括比较长期翻修率。方法：采用TriNetX联合研究网络进行回顾性队列研究。对EN-DCR或EX-DCR患者进行1年、10年和20年的年度手术量和翻修率分析。倾向得分匹配控制人口统计学和临床特征。连接点回归确定了随着时间的推移，程序率的趋势和显著变化，表示为特定间隔的年百分比变化（APC）和总体平均APC。结果：12623例患者共行14135例DCR手术（9948例EX-DCR， 4187例EN-DCR）。在研究期间，EX-DCR从87.1%下降到60.0%（平均APC， -1.9%, p < 0.05）， 2018年后下降幅度更大（APC, -3.9%, p < 0.01）。相反，EN-DCR从12.9%上升到40.1%（总体平均APC， +4.9%, p = 0.08），在2012年之后呈现显著增长（APC, +4.4%, p < 0.01）。手术翻修率相似，分别为1 （EX-DCR 9.0% vs EN-DCR 8.6%，风险比= 1.04,p = 0.61）、10 （EX-DCR 14.5% vs EN-DCR 13.6%，风险比= 1.06,p = 0.31）和20年（EX-DCR 14.7% vs EN-DCR 13.7%，风险比= 1.07,p = 0.25）。两种方法的总成功率（定义为无需手术翻修）在85.3%至91.4%之间。结论：在过去的20年里，内镜下DCR越来越受欢迎，其使用稳步增加，翻修率与外置DCR相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ophthalmic Plastic and Reconstructive Surgery 医学-外科

CiteScore

2.50

自引率

10.00%

发文量

322

审稿时长

3-8 weeks

期刊介绍： Ophthalmic Plastic and Reconstructive Surgery features original articles and reviews on topics such as ptosis, eyelid reconstruction, orbital diagnosis and surgery, lacrimal problems, and eyelid malposition. Update reports on diagnostic techniques, surgical equipment and instrumentation, and medical therapies are included, as well as detailed analyses of recent research findings and their clinical applications.