Assessment of Patient Satisfaction Following External Versus Transcanalicular Dacryocystorhinostomy

Sir,

We read with interest the article by Yeniad et al. on assessment of patient satisfaction following external versus transcanalicular dacryocystorhinostomy and evaluation of change in quality of life following simultaneous bilateral lacrimal surgery. We would like to congratulate the authors for this unique work.

However, we would like to articulate few of our observations. It would be of interest to know why the questionnaire was skipped during eight week visit? The maximum follow-up has been of 3 months. We feel it is inadequate when evaluating subjective symptoms between two very different techniques. The same holds true when evaluating the objective outcomes. It would have been more interesting if the statistical differences between groups 1 and 2 could be evaluated a little later at 6 months and then at 1 year. Although Mansour et al. concluded that the long term follow-up may negatively affect the scoring, this was limited only to subjective outcomes and can be obviated to a large extend with scoring at regular intervals right from the early post-operative period. Long term follow-ups anyways do not influence the objective outcomes, which can be of immense importance when comparing two different techniques.

Although we agree that bilateral surgery performed simultaneously prevents the patient from experiencing the stress of second surgery, it is equally possible that the stress of bilateral surgery is more than unilateral at that given point for the patient. This would be very difficult to validate and even a prospective study comparing bilateral versus unilateral would involve different patients and different perception profiles.

We once again congratulate the authors for publishing the first inter-eye comparison of patient satisfaction following external versus transcanalicular dacryocystorhinostomy.

Declaration of interest: The authors report no conflicts of interest.