title: Success rates in powered endonasal revision surgery for failed dacryocystorhinostomy in a tertiary referral center.
abstract: OBJECTIVE
  To evaluate the causes of failed dacryocystorhinostomy (DCR) surgery, recommend specific endoscopic endonasal techniques in revision DCR, and report postoperative success rates.
  
  
  METHODS
  Retrospective case series in a tertiary referral center of 19 consecutive, endonasal revision DCR surgeries in 17 adult patients with previous failed DCR. All cases were revised endonasally by 1 surgeon. Analysis of etiology of failure and techniques of surgery were supplemented by review of surgical video and medical records. Surgical outcomes were measured functionally by resolution of epiphora and anatomically by patency of nasolacrimal duct system on syringing and positive functional endoscopic dye test.
  
  
  RESULTS
  The most common cause for failed DCR was a blocked ostium due to membranous scarring (74%). Multiple causes for failure were found in 9 of 19 cases. Adjunctive procedures during revision surgery included partial middle turbinectomy (53%) and anterior ethmoidectomy (21%). The serrated oscillating blade was required in 89% cases, the high-speed diamond bur in 26%. Mean follow up was 15 months (range 7-26 months). All 19 cases had an anatomically successfully outcome. Fifteen of 19 cases (79%) had a functionally successful outcome.
  
  
  CONCLUSIONS
  In this study, the most frequent cause of failed DCR was a scarred ostium, which is optimally visualized endonasally and precisely managed with the oscillating blade. Using the abovementioned specific endonasal techniques, the authors have demonstrated a high success rate in endonasal revision DCR surgery.
authors.affiliation: Oculoplastic and Orbital Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hull
authors.forename: Shelly-Anne
authors.initials: SA
authors.lastname: Lalchan
authors.forename: Jane M
authors.initials: JM
authors.lastname: Olver
mesh_terms: D000328:Adult; D000368:Aged; D003608:Dacryocystorhinostomy; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery*; D009301:Nasolacrimal Duct / Q000473:pathology / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D017211:Treatment Failure