Abstract
Objective: Evaluate results following revision of failed endoscopic dacryocystorhinostomy (DCR).
Method: A total of 422 patients underwent endoscopic DCR unsuccessfully. Of these, 177 underwent revision endoscopic DCR. A total of 167 patients underwent removal of the medial wall of the lacrimal sac. Ten had silastic stents inserted. Parameters of success were resolution of epiphora, no further attacks of dacryocystitis, and patency of neofistula.
Results: Of the 167 patients undergoing removal of the medial wall of the lacrimal sac, 121 patients were patent following surgery. The remaining 46 got blocked again within 10 days of surgery. A total of 31 underwent a third surgery and were patent. Fifteen were lost to follow-up. Ten patients were found to have an atrophic lacrimal sac, required stenting, and were patent. None of the patients undergoing revision DCR had the medial wall of the lacrimal sac removed in the previous surgery. The procedures done on these patients previously were exposure of the lacrimal sac and drainage.
Conclusion: Revision of failed endoscopic DCR can still produce good results. A very large osteotomy and removal of the medial wall of the lacrimal sac are associated with good results.
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