External dacryocystorhinostomy: assessing factors that influence outcome.
OBJECTIVE
To present the experience of external dacryocystorhinostomy (DCR) at a tertiary referral center and investigate factors that may affect clinical outcomes.


METHODS
The clinical records of all patients who underwent external DCR at Sydney Eye Hospital between May 2000 and August 2007 were reviewed. Data were collected in regards to patient demographics, preoperative assessment, operative details, surgical technique, postoperative management, and clinical outcomes. This information was then analyzed, with emphasis on factors that influence surgical outcomes and success.


RESULTS
A total of 338 cases were reviewed. The mean age at time of surgery was 64.82 years and the majority of patients were female (65%). Epiphora was the major preoperative symptom. Assisted local anesthesia and day stay surgery were the most common surgical settings. There was a statistically significant difference in theatre time between consultant and trainee surgeons (P < 0.00001). The mean final follow-up time was 11 months. Overall, 77.3% of patients had full resolution of symptoms and 20.8% had partial resolution. Only five patients (1.9%) had no resolution of symptoms. There was no significant difference in outcomes between consultants and trainees. Patients with anatomical nasolacrimal obstruction had significantly better outcomes compared with functional obstruction (P = 0.04). The postoperative fluorescein dye disappearance test was a good predictor of clinical success (P = 0.005). Silicone intubation for greater than 6 months was associated with better outcomes (P = 0.002).


CONCLUSIONS
The results at our tertiary center are comparable to results stated in the literature. In our series, only the amount of nasolacrimal obstruction and duration of postoperative intubation influenced surgical success.
Sydney Eye Hospital, Sydney, New South Wales, Australia.
Vivek B
VB
Pandya
Scott
S
Lee
Ross
R
Benger
Jenny J
JJ
Danks
Gina
G
Kourt
Peter A
PA
Martin
Somsak
S
Lertsumitkul
Peter
P
McCluskey
Raf
R
Ghabrial
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003608:Dacryocystorhinostomy; D005260:Female; D006801:Humans; D007440:Intubation; D007767:Lacrimal Duct Obstruction / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000473:pathology / Q000601:surgery*; D012017:Referral and Consultation; D016896:Treatment Outcome; D055815:Young Adult