Histopathologic changes in the lacrimal sac of dacryocystorhinostomy patients with and without silicone intubation.
ABSTRACT To evaluate the histopathologic impact of dacryocystorhinostomy (DCR) and silicone intubation on the lacrimal sac.
Biopsy materials were taken from the sac wall and fixed (primary biopsy) in 224 patients undergoing DCR between 1995 and 2003 in our institution. A total of 23 patients underwent a second operation as the result of restenosis, and a secondary biopsy specimen was taken from the sac wall. During the initial operation, DCR and silicone intubation were combined in 13 patients (group 1), and only DCR without silicone intubation was performed in 10% patients (group 2). The histopathologic findings of the primary and secondary biopsy specimens were compared in these 23 recurrent cases. In addition, the secondary biopsy findings in the intubation and nonintubation groups were compared to determine the possible effects of the silicone intubation on the sac mucosa.
Endonasal examination of restenosis cases revealed macroscopic cicatrization. One of the cases with silicone intubation had pyogenic granuloma and two had polypoid granulation tissue at the site of anastomosis. Inflammatory polypoid development at the site of anastomosis was also observed in one case without intubation. The primary biopsy specimens of those 23 patients undergoing a second operation revealed the following findings: chronic inflammatory changes, mild fibrosis, focal ulceration in the epithelium, and a decrease in the number of goblet cells. In the secondary biopsy specimens, 2 patients in group 1 had polypoid granulation tissue, 1 patient had pyogenic granuloma, and 3 patients had exudate reflecting acute inflammation. In group 2, granulation tissue was observed in 1 case, and 2 patients had acute inflammation. There were no differences in the primary and secondary biopsy specimens of the two groups with respect to chronic inflammatory changes, focal ulceration, and the number of goblet cells (p = 0.31; 0.31, 0.65). A marked increase in fibrosis was observed in the secondary biopsy specimens of all cases (p < 0.0001). There were no significant differences between the intubation and the nonintubation groups in terms of secondary biopsy specimens (p > 0.05).
The marked increase in the intensity of fibrosis observed in the secondary biopsy specimens of all cases was the result of the tissue repair reaction against surgical manipulation rather than the effect of the silicone tube.
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ABSTRACT: To investigate the clinical affects of premature silicone stent loss after external dacryocystorhinostomy (DCR). Retrospective chart review. Two hundred thirty-three consecutive external dacryocystorhinostomies. Demographic information was recorded, including length to follow-up, age, gender, number of days until stent removal, and success of surgery. All patients who extruded their silicone stent prematurely were identified. All were primary DCRs (i.e., all reoperations were excluded). All patients had had documented nasolacrimal duct obstruction before surgery, with or without current or prior dacryocystitis. Failure of DCR surgery was accepted as symptomatic epiphora with notable nasolacrimal duct blockage and/or infection at long term follow-up. Of the 233 DCRs, 42 stents extruded or had to be removed before the planned 2-month period. The overall success rate of the surgery was 94.9%, with a 90.5% success for those who had early extrusion and 95.8% for those who did not (P = 0.24). Moreover, of the 4 people who had a failed surgery (of 42 early extrusions), none had a recurrent infection or pain, and only 1 opted to have a revision of the surgery. Patient age, gender, or timing of the extrusion was not found to affect surgical success significantly. Our experience and this study suggest that concerns over early stent extrusion or removal may not be wholly warranted. Moreover, our review of the literature shows no evidence-based recommendations that longer stent retention or reintubation after early extrusion results in a higher success rate. Although other surgeries (e.g., canalicular laceration, congenital epiphora) may benefit from intervention or reinsertion after early extrusion, we cannot extrapolate such a practice for the DCR.Ophthalmology 08/2008; 115(7):1241-4. · 5.45 Impact Factor