Purpose

Transcanalicular endoscopic laser dacryocystorhinostomy (TELDR) offers a minimally invasive alternative to conventional DCR for primary acquired nasolacrimal duct obstruction (PANDO). While short-term outcomes are favorable, long-term predictors of surgical success remain poorly defined. This review evaluates ≥12-month outcomes and identifies determinants of sustained patency.

---

Methods

We performed a systematic review of Embase, MEDLINE, and CENTRAL through March 2026. Studies reporting adult PANDO patients undergoing TELDR with ≥12 months follow-up were included. Data extracted encompassed demographics, laser type/energy, ostium size, anesthesia, adjunctive mitomycin-C (MMC), intubation, and long-term anatomical and functional success. Augmented TELDR—combining intraoperative endonasal ostium refinement and proactive postoperative maintenance—was analyzed separately.

---

Results

Thirty studies (45 cohorts, n=3,071) with mean follow-up 19.5 months were included. Standard TELDR success ranged 46–96%, with local anesthesia, ostium ≥6.3 mm, and MMC 0.4 mg/ml × 5 min consistently predicting superior outcomes. Other factors (age, gender, laser type, total energy, stenting) had variable effects. Augmented TELDR achieved high, durable success (85–92%) regardless of ostium size, MMC, stenting, or patient demographics. Long-term follow-up demonstrated stability up to 84 months.

---

Conclusion

TELDR is safe, effective, and durable for PANDO. Procedural optimization—particularly adequate ostium creation and local anesthesia—outweighs the impact of adjuncts. Augmented TELDR techniques further enhance outcomes and mitigate patient- or technique-related variability. These findings support broader adoption of TELDR, emphasizing surgical refinement and proactive ostium management as the key drivers of long-term success.

---

Additional Authors

First name	Last name	Base Hospital / Institution
Avi	Rubinov	Assuta Samson Medical Center, Ashdod, Israel

↑ Back to top