Transcanalicular laser dacro cysto rhinostomy (DCR) is a relatively rare procedure compared to more conventional external or endonasal techniques. In this article the authors examine the outcomes of revision surgery following failed transcanalicular diode laser DCR (TCDL DCR), comparing a conventional external revision with a redo TCDL DCR. They reported a 25% failure rate in 176 primary TCLD DCR procedures. Eighteen of these failures underwent external DCR revision surgery with a success rate of 94.4%, and 16 underwent redo TCLD DCR with a success rate of 43.8% (p=0.002). The main differences between the two techniques are the size of the bony ostium and the creation of a formal mucosal anastamosis with sutured flaps. Previous TCLD DCR did not compromise external revision surgery, and the authors explain this is due to the osteotomy sites being different and therefore the nasal mucosa is not scarred where the flaps are formed. Interestingly, the success of redo TCLD DCR is far lower than both revision external DCR and primary TCLD DCR, suggesting the cause of failure during primary TCLD DCR, principally scarring of the rhinostomy, is not adequately addressed during redo TCLD DCR. The 75% success rate of primary TCLD DCR is less than conventional external and endonasal non-laser methods, but it may still have a role given it is a quicker and less invasive procedure.

Comparison of revision surgeries with transcanalicular diode laser and external approaches in cases with failed transcanalicular diode laser dacryocystorhinostomy.
Buttanri IB, Ayintap E, Serin D, et al.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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