Outcomes of Powered Revision Endoscopic DCR and Utility of Three-Dimensional Computed Tomography Dacryocystography (3D CT-DCG).

Purpose: To analyze the causes of failure in primary external dacryocystorhinostomy versus endoscopic dacryocystorhinostomy and surgical outcomes of powered revision endoscopic dacryocystorhinostomy and the role of pre-operative lacrimal imaging in surgical planning.

Methods: Retrospective, interventional study on patients with an earlier failed dacryocystorhinostomy who underwent revision endoscopic dacryocystorhinostomy surgery from January 2016 to June 2024. Data collected included the demographic profile, clinical presentation, details of prior intervention, pre- and intra-operative endoscopic findings, adjunctive procedures, and the computed tomography dacryocystography characteristics. Successful outcomes were anatomic success (patent irrigation) and functional success (resolution of epiphora).

Results: Two hundred and ten lacrimal drainage systems of 205 patients who underwent revision endoscopic dacryocystorhinostomy were analyzed. The mean age at the presentation was 45 years. Of the 210 lacrimal surgeries, 17 (8%) had multiple surgeries, 129 (61%) underwent prior endoscopic dacryocystorhinostomy, and 81 (39%) had external dacryocystorhinostomy. One hundred and eight (51%) primary surgeries were performed by an ophthalmologist, 94 (45%) by an ear nose throat surgeon, and eight (3.8%) were unknown. The most common cause of failure was complete cicatricial closure (73%) followed by interfering osteo-septal synechiae (20%). The most common location of previous osteotomy was inferior (37%). Preoperative three-dimensional computed tomography-dacryocystography showed inadequate superior osteotomy in 62.5%, and sac displacement in 57%. Three-dimensional computed tomography-dacryocystography correlated with intra-operative findings in 96% cases. Adjunct procedures were performed in 42% of revision endoscopic dacryocystorhinostomy's. Successful outcome was achieved in 199 (94.7%), regardless of nature of primary surgery (p = .63), at 3-months follow-up.

Conclusion: With proper planning, comparable success to external approach can be achieved with a revision endoscopic dacryocystorhinostomy. Computed tomography dacryocystography in select cases can guide surgical planning and anticipate intra-operative challenges.