Outcomes of Powered Revision Endoscopic DCR and Utility of three-dimensional Computed Tomography Dacryocystography (3D CT-DCG)
Author: Nandini Bothra
Base Hospital / Institution: LV Prasad Eye Institute
ePoster presentation
Abstract ID: 25-406
Purpose
To analyze the causes of failure in primary external DCR(Ex-DCR) versus endoscopic DCR(En-DCR) and surgical outcomes of powered revision En-DCR and the role of pre–operative lacrimal imaging in surgical planning.
Methods
Retrospective, interve¬ntional study on patients with an earlier failed DCR who underwent revision En-DCR 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 CT-DCG characteristics. Successful outcome were anatomic success(patent irrigation) and functional success(resolution of epiphora).
Results
210 lacrimal drainage systems (LDS) of 205 patients who underwent revision En-DCR, 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 En-DCR and 81(39%) had Ex-DCR. 108(51%) primary surgeries were performed by an ophthalmologist, 94(45%) by an ENT surgeon and 8(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 3D CT–DCG showed inadequate superior osteotomy in 62.5%, and sac displacement in 57%. 3D CT–DCG correlated with intra-operative findings in 96% cases. Adjunct procedures were performed in 42% of revision En-DCR’s. Successful outcome was achieved in 199(94.7%), regardless of nature of primary surgery(p=0.63), at 3-months follow-up.
Conclusion
With proper planning, comparable success to external approach can be achieved with a revision En-DCR.CT-DCG in select cases can guide surgical planning and anticipate intra-operative challenges.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Mohammad Javed | Ali | LV Prasad Eye Institute |
| Ayushi | Agarwal | LV Prasad Eye Institute |
| Sumer | Doctor | LV Prasad Eye Institute |
| E Ravindra | Mohan | Gleneagles Eye Center and Trinethra Eye Care |
