[Establishment of the endonasal dacryocystorhinostomy technique and initial results at a German university eye hospital].

Abstract

Background: External dacryocystorhinostomy (DCR) has been performed to date with excellent functional and esthetic results. With the development of rigid endoscopy in the 1980s, endonasal DCR (EnDCR) became an effective treatment alternative. In Germany, EnDCR is currently predominantly performed by ear, nose and throat (ENT) specialists, although the indications are usually given by ophthalmologists. We describe the establishment of EnDCR at a German university eye hospital.

Methods: After setting up the necessary infrastructure (endoscopy tower, instruments), three oculoplastic ophthalmgic surgeons of the institution performed the first 6 operations under the supervision of an experienced external EnDCR surgeon. Patient age, gender, indications, operating time, learning curve (based on operating time), follow-up time, best corrected visual acuity (BCVA) preoperatively and at last presentation (logMar) as well as the subjective and objective results of lacrimal duct drainage after extubation were recorded.

Results: A total of 15 EnDCRs were carried out in 14 patients (female = 10, male = 4). The mean patient age was 63 ± 14 years. The most frequent indication for EnDCR was a status after dacryocystitis (n = 10, 71.4%), followed by primary nasolacrimal duct obstruction without previous dacryocystitis (n = 4, 28.6%). The mean operating time was 74 ± 25 min. The operating time of the first 7 procedures was significantly longer than that of the following 8 procedures (93 ± 20 min vs. 57 ± 14 min, p = 0.007). The follow-up time was 2.8 ± 2 months. The visual acuity remained unchanged during this period (0.16 ± 0.2 vs. 0.17 ± 0.2, p = 0.173). Of the patients 13 (including the bilateral EnDCR case) were symptom-free and lacrimal ducts were free of obstructions. In one patient the eye was subjectively still sticky in the morning, irrigation was normal and endoscopy was recommended for clarification.

Conclusion: The EnDCR technique can be quickly learned by experienced oculoplastic surgeons under supervision with a flat learning curve. The success rate over the short-term course (here in the small cohort so far above 90%) is comparable to the success rates of external DCR in the literature.