Predictive factors in endonasal endoscopic lacrimal surgery – a review

Predictive factors in endonasal endoscopic lacrimal surgery – a review. Objective: Endoscopic endonasal dacryocystorhinostomy (EN-DCR) is an effective surgical technique for treating symptomatic nasolacrimal duct obstruction. Although the success rate after primary EN-DCR is high, particularly in revision cases, the likelihood of failure is significant. The underlying reason for failure is primarily due to the appearance of fibrotic scar tissue at the rhinostomy site. Sometimes an obvious reason for this scarring can be detected, but most often there is no visible cause. This suggests that there could be unknown causative factors predisposing to failure in some patients. The aim of this article was to review the published literature on then predictive factors of outcomes in EN-DCR. Method: A literature search of PubMed was conducted to find and screen articles concerning predictive factors of ENDCR. Results: There seems to be several factors influencing the outcome and these are categorized into “key points in the success” and “risk factors for the failure”. Best surgical results can be achieved in experienced hands, but the previously recommended silicone intubation does not appear to improve the success rate. An antiproliferative agent, mitomycin C, can improve the outcomes in revision cases. Conclusion: The review on the topic demonstrates that the exact underlying mechanisms for success or failure in ENDCR are most likely multifactorial and not fully understood. In order to improve the quality of care in EN-DCR, there is a need to provide evidence-based recommendations that have been shown to improve clinical outcomes.