title: Long-term outcomes in revision powered endoscopic dacryocystorhinostomy.
abstract: BACKGROUND
  Long-term outcomes of revision dacryocystorhinostomy are less known. The aim of this study was to assess the long-term outcomes of revision powered endoscopic dacryocystorhinostomy (DCR).
  
  
  METHODS
  Retrospective review of all consecutive revision powered endoscopic DCRs performed over a period of 10 years from 2003 to 2012 were included. All patients completed a minimum of 12 months follow-up following stent removal. Patient records were reviewed for demographic data, type of past surgery, causes of failure, clinical and surgical profiles, adjunctive procedures, complications, and success rates at last follow-up.
  
  
  RESULTS
  Twenty-three revision powered endoscopic DCRs were performed on 18 patients who had failed primary DCR. The mean age at surgery was 61 years (range, 28-84 years). All patients presented with epiphora. Nearly 67% (66.7%; 12/18) were failed endoscopic DCRs and 33.3% (6/18) were failed external DCRs. The most common cause of failure was from cicatricial closure of ostium in 55.5% (10/18) of the cases. Over 44% (44.4%; 8/18) of patients underwent adjunctive endonasal procedures at the time of revision endoscopic DCR. The mean follow-up was 26.4 months (range, 12-66 months). A complication of ostium granuloma in 1 patient was noted, which was successfully managed. At the last follow-up, anatomical success was achieved in 91.3% of the cases and functional success in 86.9%.
  
  
  CONCLUSIONS
  Powered endoscopic DCR is a suitable option for revising failed DCRs and offers good long-term results. Meticulous evaluation to identify causative factors of failure and addressing them is crucial for successful outcomes.
authors.affiliation: Dacryology Service, L.V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Mohammad Javed
authors.initials: MJ
authors.lastname: Ali
authors.forename: Alkis James
authors.initials: AJ
authors.lastname: Psaltis
authors.forename: Peter John
authors.initials: PJ
authors.lastname: Wormald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003608:Dacryocystorhinostomy; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006099:Granuloma / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: endoscopic DCR; failed DCR; long-term; outcomes; revision DCR