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Sarah Haseltine Van Tassel, Kira Lauren Segal, Nicole Hsu, Charles Kim, Ashutosh Kacker, Gary J Lelli; Endoscopic Dacryocystorhinostomy Following Radioactive Iodine Thyroid Ablation. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4072.
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Epiphora due to nasolacrimal duct obstruction (NLDO) has been previously described as an intermediate to late sequela of radioactive iodine (RAI) ablation, namely I131, for thyroid carcinoma. Endoscopic dacryocystorhinostomy (eDCR) for treatment of NLDO has increased in popularity for avoidance of cutaneous scarring, decreased intraoperative bleeding, and shorter post-operative recovery time. As yet, the success and safety profile of eDCR for NLDO following RAI ablation has not been evaluated.
Retrospective case series of all patients ages 18 or older who underwent eDCR performed jointly by the Ophthalmology and Otolaryngology services of New York Presbyterian Hospital/Weill Cornell Medical College between 2008 and 2013 with history of thyroid cancer treated with RAI. Primary endpoints were recurrent symptoms (epiphora) and infection.
Forty-one eDCR procedures were performed on 34 patients within the study interval. Of the 41 total procedures, five were performed on patients with a history of RAI ablation for thyroid cancer; one RAI patient underwent bilateral eDCR. The series included 3 women (4 eDCR). Average patient age at the time of surgery was 50 years. Two patients had history of prior DCR, and two patients exhibited sinus pathology for which they underwent a concurrent sinus surgery at the time of eDCR. Patients were followed post-operatively for an average of 12.75 months. Both patients with a history of prior DCR developed recurrent epiphora, one with a post-operative course complicated by dacryocystitis. This was effectively treated with amoxicillin/clavulanate, and she subsequently underwent external DCR. The patient who underwent bilateral eDCR developed symptom recurrence unilaterally. Overall, the average time to recurrence of obstruction was 6 months. Eyes of two patients (67% of first-time cases) were noted to have significant symptom improvement.
Although eDCR has emerged as a safe and effective method for treating patients with NLDO, the treatment of NLDO following RAI ablation has not been evaluated. We believe we are the first to report a series of patients who underwent eDCR for NLDO associated with I131 therapy for thyroid carcinoma. It is possible that this subgroup of patients is more likely to have recurrent symptoms after eDCR, but additional longitudinal and prospective studies are needed to evaluate the potential significance of this preliminary finding.
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