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B. J. Lee, M. J. Citardi, P. S. Batra, J. D. Perry; Outcomes After Dacryocystorhinostomy in Wegener's Granulomatosis and Sarcoidosis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5334.
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To describe surgical outcomes after dacryocystorhinostomy (DCR) surgery in patient with Wegener’s granulomatosis (WG) and sarcoidosis.
Retrospective review was performed of surgeries performed from January, 2001 to January, 2008. Charts were reviewed for indications for surgery, systemic immunosuppressive medications, intraoperative biopsy results, outcomes and need for re-operations.
DCR surgery was performed for acquired nasolacrimal duct obstruction on eight sides of six patients with WG and ten sides of six patients with sarcoidosis. All surgeries were successful in the WG patients with an average follow-up of 3.6 years. All WG patients were on systemic immunosuppressive agents including methotrexate, rapamycin, and azathioprine. Intraoperative biopsy in the WG patients revealed chronic inflammation (2 patients) and fibrosis (1 patient). Surgery was successful in six of the ten surgeries in the sarcoidosis patients with an average follow-up of 20.8 months in those patients. Of the four initial failures in the sarcoidosis patients, two were successful with further surgery and two declined further surgery. Only two of the sarcoid patients were on systemic immunsuppressive agents including methotrexate and leflunomide. Biopsy in the sarcoid patients revealed non-necrotizing granulomas (6 patients) and chronic inflammation (3 patients).
DCR surgery by both external and endonasal approaches in patients with WG and sarcoidosis has good outcomes. However, long term success may be affected by recurrent inflammation, particularly if the patient is not on systemic immunosuppressive therapy. Our results suggest delayed removal of the lacrimal stent post-operatively may be indicated in patients with sarcoidosis or not on systemic immunosuppressive therapy.
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