Comparison of endonasal dcr surgery using cautery and surgical blade technique in cases of chronic dacryocystitis

Purpose: Epiphora is a clinical condition characterized by tearing of the eyes due to insufficient drainage of tears into the nasal cavity. The most common cause of epiphora is Acquired Nasolacrimal Duct Obstruction (ANDO). In adults, the standard treatment method is external dacryocystorhinostomy (Ex-DCR) surgery. In recent years, with the development and widespread use of endoscopic devices, endoscopic dacryocystorhinostomy (En-DCR) has been performed more frequently and reliably. The aim of this study is to compare the nasal synechia complications and success rates after endoscopic dacryocystorhinostomy performed using a surgical knife and cautery in cases with Acquired Nasolacrimal Duct Obstruction. Materials and Methods: Sixty patients who presented to the Ophthalmology clinic with complaints of epiphora, were diagnosed with chronic dacryocystitis after ophthalmological examination and tests, and had no nasal pathology detected in the endoscopic nasal examination performed at the otorhinolaryngology clinic were included in the study. Thirty patients underwent endoscopic dacryocystorhinostomy surgery with cautery and the other thirty with a surgical knife. Postoperative follow-up examinations were conducted at 1 and 6 months. Results: The majority of the patients were female. Overall, 50 (83.3%) patients were female and 10 (16.7%) were male. Among the female patients, 23 (46%) underwent surgery using the knife technique and 27 (54%) using the cautery technique. Among the male patients, 7 (70%) underwent surgery using the knife technique and 3 (30%) using the cautery technique. In total, 25 (41%) patients underwent surgery on the left side, 30 (50%) on the right side, and 5 (9%) bilaterally. The average age of patients in the knife technique group was 43.77±15.84 years, while the average age in the cautery technique group was 38.27±12.12 years. The minimum follow-up period for patients was 6 months. At the 1-month follow-up, nasal synechia was observed in 3 (21.4%) patients operated with the knife technique and in 11 (78.6%) patients operated with the cautery technique. This difference was statistically significant (p<0.05). At the 1-month follow-up of patients operated with the knife technique, symptoms persisted in 1 (33.3%) patient, whereas at the 6-month follow-up, symptoms persisted in 7 (43.8%) patients. At the 1-month follow-up of patients operated with the cautery technique, symptoms persisted in 2 (66.7%) patients, whereas at the 6-month follow-up, symptoms persisted in 9 (56.3%) patients. A success rate of 76.6% was achieved in patients who underwent the knife technique, and a success rate of 70% was achieved in patients who underwent the cautery technique. Conclusion: Our study observed that the knife technique in endoscopic dacryocystorhinostomy had a lower potential for nasal synechia complications compared to the cautery technique, and that the success rates of both techniques were the same. Keywords: Epiphora, cautery technique, knife technique, nasolacrimal duct obstruction, endoscopic endonasal dacryocystorhinostomy, dacryocystitis.