Predictors of Success and Long-Term Outcome in Endoscopic Dacryocystorhinostomy: Single-Center Study.

Abstract

BackgroundEndoscopic dacryocystorhinostomy (eDCR) is the preferred surgical treatment for nasolacrimal duct obstruction. However, long-term outcome data and reliable predictors of surgical success remain limited.ObjectiveTo assess long-term functional outcomes of eDCR and identify factors associated with recurrence in a large single-center cohort with long-term follow-up.MethodsWe conducted a retrospective cohort study including all patients who underwent primary endonasal eDCR between 1998 and 2022 at a tertiary referral center. Primary outcomes were functional success (absence of epiphora) after first and, if necessary, second surgery, and time to recurrence following primary eDCR. Recurrence-free survival was analyzed using Kaplan-Meier methods and Cox proportional hazards regression. Secondary outcomes included concordance among preoperative diagnostic tests and perioperative complications.ResultsA total of 280 patients underwent 313 primary unilateral eDCR procedures. Functional success after first surgery was achieved in 86.9% of cases, with 41 recurrences (13.1%). After secondary procedures, 95.2% of operated sides were symptom-free. Estimated recurrence-free survival was 93.5% at 1 year, 90.8% at 3 years, and 88.5% at 5 years. On multivariable analysis, concomitant unciformectomy was independently associated with a reduced risk of recurrence (hazard ratio 0.27; 95% CI, 0.13-0.56; P < .001). Agreement among preoperative diagnostic tests was limited, with only fair concordance between fluorescein testing or dacryography and dacryo-CT-scan imaging (Cohen's κ 0.25-0.29). No major surgical complications were observed.ConclusioneDCR provides durable long-term relief of epiphora with high functional success rates. Concomitant unciformectomy appears to reduce the risk of recurrence significantly and may represent an important surgical step in optimizing long-term outcomes. Limited concordance among preoperative diagnostic tests supports the use of a complementary diagnostic approach in clinical practice.