Intraoperatively Observed Lacrimal Obstructive Features and Surgical Outcomes in External Dacryocystorhinostomy
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Purpose: To analyze the features of lacrimal drainage system obstruction confirmed during external dacryocystorhinostomysurgeries and report the surgical outcomes. Methods: We reviewed the medical records of a total of 769 cases who underwent external dacryocystorhinostomyfor primary lacrimal drainage obstruction between 2005 and 2014. Data about detailed location andextent of obstruction were collected intraoperatively. The sites of obstruction were classified into nasolacrimalduct obstruction (NLDO), common canalicular obstruction (CCO), and canalicular obstruction. Lacrimalsac mucosa and lumen were grossly inspected, and the frequency of lacrimal sac changes, such as significantinflammation or fibrosis, was analyzed in cases of CCO or canalicular obstruction. The surgical successrate was also evaluated including effect of lacrimal sac status in the CCO and canalicular obstruction groups. Results: Of 769 cases, primary NLDO with patent canaliculi was diagnosed intraoperatively in 432 cases(56.2%), CCO in 253 (32.9%), and canalicular obstruction in 84 (10.9%). Of 253 cases with CCO, 122 (48.2%)showed clear lacrimal sac lumen, and the other 131 (51.8%) showed significant inflammation or fibrosis ofthe lacrimal sac. In cases with canalicular obstruction, 35 of 84 (41.7%) showed a clear lacrimal sac, and theother 49 cases (58.3%) cases revealed mucosal changes of the lacrimal sac. The functional success ratewas 87.5% for primary NLDO, 75.5% for CCO, and 72.6% for canalicular obstruction. In the CCO group, thefunctional success rate was lower in cases with significant lacrimal sac change (p = 0.044). Conclusions: Even in patients with CCO or canalicular obstruction, a large number of cases have lacrimal sacchanges, and those changes were associated with lower functional success rate.
Abstract
Purpose: To analyze the features of lacrimal drainage system obstruction confirmed during external dacryocystorhinostomysurgeries and report the surgical outcomes. Methods: We reviewed the medical records of a total of 769 cases who underwent external dacryocystorhinostomyfor primary lacrimal drainage obstruction between 2005 and 2014. Data about detailed location andextent of obstruction were collected intraoperatively. The sites of obstruction were classified into nasolacrimalduct obstruction (NLDO), common canalicular obstruction (CCO), and canalicular obstruction. Lacrimalsac mucosa and lumen were grossly inspected, and the frequency of lacrimal sac changes, such as significantinflammation or fibrosis, was analyzed in cases of CCO or canalicular obstruction. The surgical successrate was also evaluated including effect of lacrimal sac status in the CCO and canalicular obstruction groups. Results: Of 769 cases, primary NLDO with patent canaliculi was diagnosed intraoperatively in 432 cases(56.2%), CCO in 253 (32.9%), and canalicular obstruction in 84 (10.9%). Of 253 cases with CCO, 122 (48.2%)showed clear lacrimal sac lumen, and the other 131 (51.8%) showed significant inflammation or fibrosis ofthe lacrimal sac. In cases with canalicular obstruction, 35 of 84 (41.7%) showed a clear lacrimal sac, and theother 49 cases (58.3%) cases revealed mucosal changes of the lacrimal sac. The functional success ratewas 87.5% for primary NLDO, 75.5% for CCO, and 72.6% for canalicular obstruction. In the CCO group, thefunctional success rate was lower in cases with significant lacrimal sac change (p = 0.044). Conclusions: Even in patients with CCO or canalicular obstruction, a large number of cases have lacrimal sacchanges, and those changes were associated with lower functional success rate.
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