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.