View 2024 Abstracts

Purpose

To showcase the evolution of treatment performed for primary acquired nasolacrimal duct obstruction (PANDO) in a single tertiary institute over the last 20 years by a single surgeon.

Methods

Retrospective analysis of surgeries performed for PANDO in the operating room from August 2002 to December 2023.

Results

Over 20 years, 5649 oculoplastic cases were performed. Of these, 764 (13.5%) were lacrimal drainage surgeries. 616 (80.6%) surgeries were conducted for nasolacrimal duct obstruction(NLDO); Indications per eye included 425 (69.0%) PANDO, 159 (25.8%) congenital primary acquired nasolacrimal duct obstruction and 7 (1.1%) secondary acquired NLDO.

Analysing those that underwent surgery for PANDO (n=367), 60 (16.3%) patients had bilateral concurrent surgeries, 2 (0.5%) had bilateral non-concurrent surgeries and 305 (83.1%) had unilateral. Mean age was 64.36+/-15.91 years and 266 (72.5%) were females. External dacryocystorhinostomy (DCR) was performed for 207(48.8%), endoscopic DCR for 138 (32.5%) and endoluminal duct recanalisation (ELDR) for 80 (18.8%) eyes.

Comparing the types of procedures done in the last 4 years, from 2020-2021: 6 (10.5%) ELDR, 22 (38.6%) endoscopic DCR, 29 (50.9%) external DCR; 2022-2023: 15 (25.4%) ELDR, 29 (49.2%) endoscopic DCR, 15 (25.4%) external DCR [Chi-Squared Test P=0.01]. There was statistically significant difference between the types of surgeries performed; ELDR and endoscopic DCR were more prevalent in recent years. Rates of complete cure (epiphora) were as follows: ELDR 56.3%, external DCR 63.3% and endoscopic DCR 75.4% [Chi-Squared Test P=0.08].

Conclusion

Preference in treatment of PANDO has shifted from external DCR to ELDR. ELDR (a form of Natural Orifice Transluminal Endoscopic Surgery(NOTES)) is an emerging field which is the least invasive alternative to the treatment of PANDO as it avoids the necessity of making new bony openings. Although ELDR had slightly lower rate of complete cure compared to external DCR, it could be considered as a first line procedure, especially since it could be performed as an office-based procedure.