Prospective comparison of 3 dacryocystorhinostomy surgeries: external versus endoscopic versus transcanalicular multidiode laser.

Purpose: To analyze the clinical outcomes of external (EX-), endoscopic (EN-), and transcanalicular multidiode laser (TC-) with dacryocystorhinostomy (DCR).

Methods: Ninety-two patients with primary acquired nasolacrimal duct obstruction were enrolled (divided into EX-DCR [n = 33], EN-DCR [n = 30], and TC-DCR groups [n = 29]) in this prospective study. Primary outcome measures were the anatomical and functional success of operations at the last control examination. Secondary outcome measures were the ostium size, surgical time, and complications.

Results: The difference in mean surgical time among the 3 groups was statistically significant (p < 0.0001). External DCR required the longest surgical time (46.6 ± 15.3 minutes), while TC-DCR was the shortest (20.3 ± 7.7 minutes). There were no significant differences between the groups regarding anatomical (81.8%, 75.9%, and 76.7% in EX-, EN-, and TC-DCR groups, respectively; p = 0.824) and functional success rates (81.8%, 72.4%, and 73.3% in EX-, EN-, and TC-DCR groups, respectively; p = 0.626). Final ostium size was the largest with EX-DCR (33.7 ± 17.4 mm) and smallest with EN-DCR (19.0 ± 8.9 mm; p = 0.001). The complication rate was similar in all groups. The most common complications were the formation of granulation tissue (16.3%) and intranasal synechiae (9.8%), all of which led to surgical failure and were more frequent in the EN- and TC-DCR groups.

Conclusions: External DCR, EN-DCR, and TC-DCR had similar success and complication rates in patients with primary acquired nasolacrimal duct obstruction. External DCR resulted in the largest ostium size. Transcanalicular DCR appeared to be effective with the shortest surgical time.