Osteotomy Techniques in Endoscopic Dacryocystorhinostomy: A Three-Decade Comparative Cohort Study.

OBJECTIVE

Endoscopic dacryocystorhinostomy (DCR) is a well-established surgical procedure used to restore lacrimal drainage in patients with nasolacrimal duct obstruction. Various instrumentation techniques have been used for lacrimal bone osteotomy; however, their comparative effectiveness remains debated. This study aimed to evaluate surgical outcomes of endoscopic DCR performed using four different instrumentation techniques.

METHODS

This retrospective comparative cohort study included 360 consecutive endoscopic DCR procedures performed on 312 adult patients between 1995 and 2024 in a tertiary care center. All surgeries were performed by a single surgeon. Osteotomy was performed using a drill, microdebrider, Kerrison punch, or thulium:YAG laser. Surgical success was defined as resolution of symptoms and confirmation of a patent neo-ostium on follow-up. Comparative statistical analysis was performed to evaluate differences in success rates among techniques.

RESULTS

The overall success rate was 95.3%. Success rates were comparable across all instrumentation techniques, with no statistically significant difference observed between groups (p = 0.99). Minor postoperative complications occurred in 2.8% of procedures.

CONCLUSION

Endoscopic DCR demonstrated high success rates across all instrumentation modalities. Surgical outcome appears to depend more on surgical technique and experience than on the specific instrument used for osteotomy.