Abstract
Objective
To evaluate the long-term anatomical and functional efficacy of a hybrid surgical technique combining endoscopic dacryocystorhinostomy (En-DCR), endoscopic common canaliculotomy, and temporary bicanalicular silicone intubation in patients with severe common canalicular obstruction (CCO).
Methods
This retrospective case series analyzed 43 eyes of 43 patients (mean age: 55.4 ± 8.0 years) with severe CCO treated between February 2018 and July 2022. Severe CCO was confirmed intraoperatively by soft resistance to probing ≥10 mm from the punctum. The surgical technique included wide bony ostium creation, lacrimal sac marsupialization, direct endoscopic incision of the fibrotic common canaliculus, and bicanalicular silicone tube intubation (stent removed at 3 months). Outcomes were assessed at ≥12 months postoperatively using epiphora symptom resolution, lacrimal irrigation, nasal endoscopy, and fluorescein dye disappearance test. Anatomical success was defined as a patent ostium with unobstructed irrigation; functional success required anatomical patency plus complete epiphora resolution.
Results
At a mean follow-up of 18.8 ± 6.9 months, anatomical success was achieved in 37 eyes (86.0%), and functional success in 35 eyes (81.4%). Failures included 5 cases of ostial fibrosis and 1 recurrent CCO; 2 patients reported persistent epiphora despite anatomical patency. No major complications (eg, orbital hemorrhage, sinusitis) occurred.
Conclusions
In carefully selected patients with isolated severe CCO, the hybrid technique of En-DCR with canaliculotomy and temporary intubation demonstrates promising success rates and a favorable safety profile while preserving physiological drainage. These findings suggest it may serve as a physiologically favorable alternative to conjunctivodacryocystorhinostomy, mitigating the long-term complications associated with permanent bypass tubes.
Keywords
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