Clinical Ophthalmology (Nov 2024)
Factors Influencing Endoscopic Dacryocystorhinostomy Outcomes: A Comprehensive Clinical and Histopathological Analysis and Review of the Literature
Abstract
Andrzej Sieśkiewicz,1 Bartosz Piszczatowski,1 Joanna Reszeć,2 Michał Sieśkiewicz,3 Zuzanna Micun,3 Joanna Konopińska4 1Department of Otolaryngology, Medical University of Bialystok, Białystok, Poland; 2Department of Medical Pathomorphology, Medical University of Bialystok, Bialystok, Poland; 3Faculty of Medicine, Medical University of Białystok, Bialystok, Poland; 4Department of Ophthalmology, Medical University of Bialystok, Białystok, PolandCorrespondence: Joanna Konopińska, Department of Ophthalmology, Medical University of Bialystok, M. Sklodowska-Curie 24A Street, Białystok, 15-276, Poland, Tel/Fax +48 600471666, Email [email protected]: The main challenge in maintaining long-term success of endoscopic dacryocystorhinostomy is preventing fibrosis and scarring at the anastomosis site. Despite numerous studies on surgical techniques, research on histological factors linked to postoperative scarring is limited. This study evaluated long-term (range, 12– 18 months) outcomes and systematically examined clinical and histopathological factors that may contribute to restenosis.Patients and Methods: This retrospective study included 47 patients who underwent a unilateral surgery intervention for primary acquired lacrimal duct obstruction. The following clinical and histopathological variables were considered to assess the risk factors for the development of restenosis: sex, age, duration of disease, clinical manifestation of disease, clinical features of the lacrimal sac perceived intraoperatively, fibrosis, and mononuclear cell infiltrates.Results: Statistical analysis showed that only patient sex (Pearson’s chi-squared test, p = 0.007) and severity of intraoperative adhesions in the lacrimal sac (Pearson’s chi-square test, p = 0.029) were significantly linked to restenosis. However, the skewed male-to-female ratio, few surgical failures make the conclusion that sex is a risk factor speculative. Thus, only adhesion intensity can be considered a risk factor. Additionally, fibrosis assessed using trichrome staining and T-cell lymphocytic infiltration showed potential negative prognostic value in a larger cohort.Conclusion: Our findings indicate that patients with significant lacrimal sac adhesions, identified during endoscopic dacryocystorhinostomy, are particularly prone to postoperative restenosis. Although histological and immunohistochemical studies did not reveal a correlation between the analyzed data and restenosis, a larger patient cohort might show that fibrosis and T-cell lymphocytic infiltration could potentially have a negative prognostic value. The poorer treatment outcomes in women, seen in our study as well as in other investigations, may be due to anatomical and physiological traits of the female lacrimal drainage system that predispose them to stenosis. This hypothesis requires further study in a larger cohort.Keywords: fibrosis, lacrimal sac, restenosis, tearing
