Abstract
Background Dacryocystorhinostomy (DCR) is regarded as the gold standard for the treatment of
chronic dacryocystitis (CDC). Different modifications of the surgical procedure have
been developed over the years.
Methods Patients with CDC due to postsaccal lacrimal stenosis and under treatment with DCR
have been included in this retrospective study. Two groups of different surgical procedures
were analysed: firstly DCR without reconstruction of the ductus nasolacrimalis (DNL,
group 1) and secondly patients with reopening the DNL (group 2). Criteria for success
were absence of permanent epiphora, absence of inflammation of the lacrimal sac (functional
success), and no recurrent surgery with free patency of the lacrimal duct (anatomical
success). This was obtained by questionnaire after a follow-up of at least 12 months.
The impact of gender, ectasia of the lacrimal sac, dacryoliths, and prior lacrimal
surgeries was analysed.
Results Overall, 248 surgeries were enrolled in this trial. Mean age in group 1 was 68 years
(range: 22 to 92 years) and gender ratio was 3.2 to 1 (female : male). In that group,
68 operations could be followed up. In group 2, 62 operations on patients of a mean
age of 63 years (range: 24 to 89 years) and a gender ratio of 2.9 to 1 (female : male)
were observed. Complete success occurred in 75.0% in group 1 and 75.8% in group 2.
Recurrent operations were necessary in one case of group 2 (1.6%) and 4 cases of group
1 (5.9%). Gender (group 1 p = 1; group 2 p = 0.115; between groups p = 0.511), ectasia
of the lacrimal sac (group 1 p = 0.877; group 2 p = 0.674; between groups p = 0.878),
dacryolith (group 1 p = 1; group 2 p = 0.465; between groups p = 1), and prior lacrimal
surgery (group 1 p = 0.092; group 2 p = 0.051; between groups p = 0.520) did not influence
the success rates in each group or between groups. Significantly more dacryoliths
were found during operations
of group 2 (p = 0.010).
Conclusion Reconstruction of the DNL during DCR is a possible and easy modification, with a
slightly better success rate in curing CDC. Intraoperatively, dacryoliths might not
be apparent remain in the deeper parts of the lacrimal ducts. Therefore, these segments
should be inspected during surgery.
Key words
dacryocystorhinostomy - nasolacrimal ducts - lacrimal intubation - patient satisfaction
- functional success - anatomical success
