Revision of failed dacryocystorhinostomies using the transcanalicular approach. Results of 118 procedures

Purpose: To assess the efficacy of transcanalicular dacryocystorhinostomy f or the revision of other procedures. The results are analyzed following the use of two different types of laser. the Neodymium: YAG (Nd: YAG) laser an d the Holmium: YAG (Ho: YAG) laser. To study the efficacy of using two anti metabolite drugs in this context: mytomycin-C (MMC) and 5-fluoro-uracile (5 -FU). Methods: One hundred and fourteen patients were operated on. Of these, 88 h ad already undergone one procedure, 25 hive procedures, and 5 three procedu res. The Nd: YAG laser was used in 78 procedures, the Ho: YAG in 30 procedu res, and both lasers in 10 procedures. Twenty patients were treated with an application of MMC and 25 patients with an application of 5-FU. Results: The results are based on 106 procedures. The total success rate wa s 49.06% after one revision and 58.49 % after two or three revisions. There is no statistically significant difference between the Nd: YAG and Ho: YAG lasers. The use of antimetabolites did not improve the success rate. Conclusion: Transcanalicular dacryacystorhinostomy is a very useful method because it does not cause cutaneous scarring and it has a low rate of morbi dity given that it causes very little surgical traumatism. The revision of other dacryocystorhinostomy methods using the transcanalicular approach is theoretically a positive indication because it dues not dissect scarring ti ssues and because the osteotomy has already been performed. However, the su ccess rate is lower than for the external and endonasal approaches. The suc cess tate is nut modified by the use of antimetabolites or by the type of l aser.