CHRONIC INFLAMMATORY SCORE IN PATIENTS WITH DACRYOCYSTORHINOSTOMY AND CORRELATION WITH SURGICAL OUTCOME
Keywords:
Dacryocystitis,, Dacryocystorhinostomy,, Lacrimal sac, histopathlogy, chronic inflammatory scoreAbstract
Background: Dacryocystorhinostomy (DCR) is an ophthalmic surgical procedure for relieving obstruction from chronically inflamed nasolacrimal duct (chronic dacryocystitis). This study was performed to observe the surgical outcome of DCR in patients with chronic dacryocystitis; to grade the inflammation in lacrimal sac biopsies, using the chronic inflammatory score (CIS); and to correlate the CIS with the surgical outcome. Methods: Twenty-five patients with chronic dacryocystitis underwent DCR with lacrimal sac biopsies. The biopsies were examined microscopically, and a CIS score was assigned and graded into mild, moderate and severe. The patients were followed up. The success of DCR was evaluated at 6 months post-surgery, by syringing of the lacrimal tract. Results: The mean age of the patients was 37.76 years±12.32 SD. The mean duration of watering of the eye was 2.9 years±3.18 years. The right eye was involved in 60% and 80% of the patients were females. Severe inflammation was reported in 72%, moderate angiogenesis in 76% and moderate fibrosis in 72%, squamous metaplasia in 40%, and a reduced number of goblet cells in 72% of the biopsies. CIS was severe in 72% of the patients. At 6 months follow-up, 96% of the patients had a successful DCR. Conclusion: Although the chronic inflammatory score was severe, the DCR was successful in most of the patients, suggesting that the success of the surgical procedure is not related to the degree of inflammation. Large-scale studies are recommended for confirmation of our findingsReferences
Ghose S, Jha RK, Nayak N, Satpathy G. Current Microbial Correlates of the Eye and Nose in Dacryocystitis – Their Clinical Significance. AIOC Proc 2005;2005:437–9.
Heindl LM, Treutlein E, Jünemann AG, Kruse FE, Holbach LM. [Selective lacrimal sac biopsy for external dacryocystorhinostomy: a clinical pathological study]. Ophthalmologe 2010;107(12):1139–44.
Chatta RU, Latif S, Imran H, Aslam N. Analysis and Efficacy of Dacryocystorhinostomy Performed with Nasal Endoscope and its Advantage over External Dacryocystorhinostomy. Pak J Med Sci 2012;6(2):329–31.
Marthin JK, Lindegaard J, Prause JU, Heegaard S. Lesions of the lacrimal drainage system: a clinicopathological study of 643 biopsy specimens of the lacrimal drainage system in Denmark 1910–1999. Acta Ophthalmol Scand 2005;83(1):94–9.
Amin RM, Hussein FA, Idriss HF, Hanafy NF, Abdallah DM. Pathological, immunohistochemical and microbiological analysis of lacrimal sac biopsies in patients with chronic dacrocystitis. Int J Ophthalmol 2013;6:817–26.
Chakrabarti S, Dasgupta S, Banerjee M, Pal D. Role of histomorphology and chronic inflammation score in chronic dacryocystitis. J Clin Diagn Res 2016;10:EC1–3.
Ullrich K, Malhotra R, Patel BC. Dacryocystorhinostomy. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2023 April]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557851/
Mukhtar SA, Jamil AZ, Ali Z. Efficacy of external dacryocystorhinostomy (DCR) with and without mitomycin-C in chronic dacryocystitis. J Coll Physicians Surg Pak 2014;24(10):732–5.
Leong SC, MacEwen CJ, White PS. A systematic review of outcomes after dacryocystorhinostomy in adults. Am J Rhinol Allergy 2010;24:81–90.
Ali MJ, Singh M, Chisty N, Kamal S, Naik MN. Endoscopic ultrasonic dacryocystorhinostomy: clinical profile and outcomes. Eur Arch Otorhinolaryngol 2016;273(7):1789–93.
Park J, Lee J, Baek S. Pathologic features and expression of heat shock protein 47 in the nasal mucosa and lacrimal sac: does it influence the surgical outcome of endoscopic endonasal dacryocystorhinostomy? Eye (Lond) 2018;32(9):1432–39.
Mauriello JA Jr, Palydowycz S, DeLuca J. Clinicopathologic study of lacrimal sac and nasal mucosa in 44 patients with complete acquired nasolacrimal duct obstruction. Ophthalmic Plast Reconstr Surg 1992;8(1):13–21.
Eldsoky I, Ismaiel WF, Hasan A, Abdelazim MH, Ibrahim AA, Alsobky ME, et al. The predictive value of nasolacrimal sac biopsy in endoscopic dacryocystorhinostomy. Ann Med Surg (Lond) 2021;65:102317.
So HR, Kim JH, Kim SE, Yang SW. The clinical utility of routine histological biopsy during dacryocystorhinostomy. J Korean Ophthalmol Soc 2020;61(11):1251–6.
Mohamed R, Nabil R, Elzankalony Y, Zaki A, Elwan S. Clinical-to-Pathological Correlation of Lacrimal Sac Specimens Obtained During Dacryocystorhinostomy Surgery. Egypt J Histol 2021;44(4):1071–80.
Irfan FB, Irfan BB, Spiegel DA. Barriers to accessing surgical care in Pakistan: healthcare barrier model and quantitative systematic review. J Surg Res 2012;176(1):84–94.
Ozer O, Eskiizmir G, Unlü H, Işisağ A, Aslan A. Chronic inflammation: a poor prognostic factor for endoscopic dacryocystorhinostomy. Eur Arch Otorhinolaryngol 2012;269(3):839–45.
Costea CF, Dumitrescu GF, Turliuc MD, Dimitriu G, Chihaia MA, Indrei L, et al. A 16- year retrospective study of dacryocystitis in adult patients in the Moldavia Region, Romania. Rom J Morphol Embryol 2017;58(2):537–44.
Paulsen F. The human nasolacrimal ducts. Adv Anat Embryol Cell Biol 2003;170:III–XI,1–106.
De Paiva CS, Villarreal AL, Corrales RM, Rahman HT, Chang VY, Farley WJ, et al. Dry Eye–Induced Conjunctival Epithelial Squamous Metaplasia Is Modulated by Interferon-γ. Invest Ophthalmol Vis Sci 2007;48(6):2553–60.
Goyal A, Dipalma D, Goyal R. The Role of Goblet Cells in the development of Dacryostenosis. Invest Ophthalmol Vis Sci 2015;56(7):4763.
Ishikawa M, Kubo M, Maeda S, Sawada Y, Uchio E, Yoshitomi T. Structural changes in the lacrimal sac epithelium and associated lymphoid tissue during experimental dacryocystitis. Clinic Ophthalmol 2011;5:1567–74.
Bernardini FP, Moin M, Kersten RC, Reeves D, Kulwin DR. Routine histopathologic evaluation of the lacrimal sac during dacryocystorhinostomy: how useful is it? Ophthalmology 2002;109(7):1214–7.
Badhu B, Dulal S, Kumar S, Thakur SK, Sood A, Das H. Epidemiology of chronic dacryocystitis and success rate of external dacryocystorhinostomy in Nepal. Orbit 2005;24(2):79–82.
Fay A, Dolman PJ. Diseases and disorders of the orbit and ocular adnexa. 1st edition, Elsevier Health Sciences, 2016; p.174.
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