Transcanalicular-endonasal semiconductor diode laser-assisted revision surgery for failed external dacryocystorhinostomy

PURPOSE: To report the results of transcanalicular-endonasal revision dacryocystorhinostomy (DCR) with a semiconductor diode laser in cases of failed external DCR. DESIGN: Prospective, nonrandomized, interventional case series. METHODS: Fifteen cases in 13 patients with failed external DCR underwent transcanalicular-endonasal DCR with a semiconductor diode laser. A functional successful outcome was defined as a patent nasolacrimal drainage system in nasolacrimal irrigation and a resolution of the symptomatic epiphora and/or mucoid discharge. RESULTS: The patients were followed for a mean postoperative period of 27.3 months (range, nine to 54 months). The mean duration of the surgery was 19.6 minutes. After the initial revision transcanalicular-endonasal DCR surgery, patency to irrigation was obtained in 12 cases (80%), and 15 cases (100%) after a second revision treatment. Three cases required repeated revision surgery, and three other cases were considered to be functional failures in spite of a patent lacrimal system after the final revision surgery. The overall functional success rate was 80% (12 cases) at the final examination (mean, 27.3 months after surgery), and there were no intraoperative and postoperative complications. The presence of a canalicular obstruction or granulation tissue was not significantly related to the success rates of the revision surgery. The length of time between the primary and revision surgery, gender, age, the duration of the first revision surgery, and the timing of stent removal were also not significantly related to the failed cases. CONCLUSION: Transcanalicular-endonasal DCR is a minimally invasive procedure and is recommended for patients as an alternative procedure for failed external DCR.