The clinical analysis of endonasal dacryocystorhinotomy on treatment of the recurrent dacryocystitis after polyurethane stent placement

Abstract

Purpose : Recent works have shown that patients who have long-term implantation of polyurethane nasolacrimal duct stents to treat ocstruction of lacrimal passage may have a risk of recurrent dacryocystitis. We used endonasal dacryocystorhinotomy (EN-DCR) to treat these recurrent dacryocystitis patients and studied the therapeutic strategies, operating methods and prognosis for these recurrent dacryocystitis patients.

Methods : This retrospective study included 26 cases (28 eyes) which were diagnosed as the recurrent dacryocystitis after long-term polyurethane stent placement. During treatment, some patients were implanted with silicone tubes while others were implanted with silicone tubes combined with Mero Gel applicator. Biopsies performed on lacrimal sac mucosa in 4 patients. During the 2^th , 4^th and 6^th weeks post-operative, endoscopic examination were performed for patency of lacrimal duct, healing of anastomotic mucosa, granulation of anastomotic. Follow-up time was 6 months ~ 12 months.

Results : 1) The majority of the anastomosis epithelialized within 4 weeks. 2) Success rate, defined by the proportion for free of epiphora symptoms post-operation, was 96.4%，85.7%，71.4%, respectively. 3) Epiphora symptom disappeared in 20 eyes after extubation among 28 eyes. Mild epiphora recurred in 7 eyes within 1~3 months after extubation 2). Medpor-coated tear drain was planted in 1 eye to solve the complication of canaliculi and common canaliculi re-occlusion. 4) Endoscopic examination of lacrimal sac revealed chronic inflammation, increased scarring formation in 28 eyes. Increased granulation and mucosa thickening on lacrimal sac surface among 23 eyes and mucosa of lacrimal sac in 5 eyes developed into atrophy. Biopsies didn’t show any malignant change on the mucosa of lacrimal sac in 4 eyes.

Conclusions : The endonasal dacryocystorhinotomy can achieve a good recovery rate on treatment of recurrent dacryocystitis resulting from long-term implanting polyurethane nasolacrimal duct stents. However, because of the abnormal structure of mucosa caused by the long-term implantation, prognosis is not as good as conventional dacryocystitis. The long-term implantation of stent made by polyurethane may potentially stimulate dacryocyst mucosa and cause the recurrent dacryocystitis, may not suitable for long-term treatment for obstruction of lacrimal passage.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.