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The surgeon sutured the lacrimal sac mucosa with the nasal mucosa by tying knots under endoscopic DCR. Subject demographics, preoperative data and postoperative data were collected, including clinical presentation, Munk score for epiphora, surgical indications, operation time, duration of knotting, number of knots, endoscopic ostium size, complications, and anatomical and functional success. Anatomic success was defined as patent ostium on lacrimal irrigation, and functional success was defined as subjective improvement in symptoms. Statistical analysis was performed by IBM SPSS software (Version 20.0; SPSS Inc., Chicago, IL, USA).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 60 patients (71 eyes) underwent pure eSK-DCR. Of these, 95.0% (57\/60) were females. The mean age of the patients was 54.7\u00a0years. The mean surgical time was 37.60\u00a0min, and the average time for each knotting was 2.86\u00a0min. Endoscopic evidence found that all patients showed patent ostium and normal healing of the flaps after 4\u00a0weeks. The Munk scores dropped significantly at 6\u00a0months postoperatively compared to preoperative scores (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001). Although 4 patients (7 eyes) were lost to follow-up at the end of the 2-year period, the anatomical and functional success remained stable during the 2-year follow-up period (anatomical, 100%; functional, 87.5%). No serious complications were detected during the follow-up period.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Pure eSK-DCR is a simple and reliable therapeutic method for the management of NLDO. The surgical outcomes were good and remained stable beyond 6\u00a0months postoperatively.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s10792-022-02388-1","type":"journal-article","created":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T11:05:32Z","timestamp":1657883132000},"page":"63-71","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["A simple and efficient technique for suturing and knotting during endoscopic dacryocystorhinostomy"],"prefix":"10.1007","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4867-8331","authenticated-orcid":false,"given":"Rongxin","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4013-5295","authenticated-orcid":false,"given":"Shu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aixin","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1472-3595","authenticated-orcid":false,"given":"Aizezi","family":"Wumaier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanxia","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinyue","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziwei","family":"Meng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4426-9792","authenticated-orcid":false,"given":"Yuxiang","family":"Mao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5408-5538","authenticated-orcid":false,"given":"Xuanwei","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,7,15]]},"reference":[{"key":"2388_CR1","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1097\/icu.0000000000000084","volume":"25","author":"MM Marcet","year":"2014","unstructured":"Marcet MM, Kuk AK, Phelps PO (2014) Evidence-based review of surgical practices in endoscopic endonasal dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction and other new indications. 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