Surgical Outcomes of Endonasal Revision Surgery for Failed DCR According to Number of Silicone Tubes

PURPOSE: To evaluate the causes of failed dacryocystorhinostomy (DCR) and the effects of transcanalicular diode laser-assisted endonasal revision surgery according to the number of silicone tubes. METHODS: Sixty-seven patients (70 eyes) who underwent revision surgery using transcanalicular diode laser for failed primary endonasal DCR at Sungmo Eye Hospital between March 2007 and December 2012 were studied retrospectively. The causes of failed DCR and the time of recurrence were evaluated. The revision surgeries were endoscopic removal of granuloma and membrane and synechiolysis with intubation of 1 or 2 silicone tubes. We compared the results of revision surgery with 1 silicone tube and 2 silicone tube intubations. RESULTS: Recurrence occurred after a mean duration of 4.6 months following the first DCR. The causes of surgical failure were granuloma (35 eyes), membranous obstruction (23 eyes), synechia (7 eyes), and functional obstruction (5 eyes). We performed revision surgery with 1 silicone tube intubation in 45 eyes (group A) and 2 silicone tube intubations in 25 eyes (group B). The final success rates in groups A and B were 75.6% (34/45) and 84% (21/25), respectively (chi-square test, p = 0.828). CONCLUSIONS: Transcanalicular diode laser-assisted endonasal revision surgery with 2 silicone tubes is not recommended.

Effects of Double Silicone Tube Intubation for Nasolacrimal Duct Obstruction in Adults

PURPOSE: To evaluate the effectiveness of double silicone tube intubation in the treatment of nasolacrimal duct (NLD) obstruction in adults. METHODS: We treated 159 eyes of 159 patients with NLD obstruction. The resolution of preoperative symptoms and signs of NLD obstruction was evaluated two months after the removal of the silicone tubes. RESULTS: The mean age of patients was 57.9 years and the mean follow-up period was 8.5 months. The symptoms and signs of NLD obstruction were reduced in 85.6% of the patients. The partially obstructed group showed a higher lacrimal patency rate (93.0%) than the completely obstructed NLD group (82.7%). There was no discomfort due to the double silicone tubes. There was a punctal slit in 13 eyes, prolapse of silicone tubes to ocular side in 5 eyes and 3 eyes had punctum to punctum adhesion after the procedure. CONCLUSIONS: Double silicone tube intubation is an effective therapy in adults with NLD obstruction, especially for those with partially obstructed NLD. Indications were seen that these tubes keep greater dilatation of the NLD.