Chronic inflammation: a poor prognostic factor for endoscopic dacryocystorhinostomy

Abstract

Endoscopic endonasal dacryocystorhinostomy (En-DCR) success can be affected by many factors. In this study, we aimed to determine the effect of chronic inflammation on the surgical outcome of En-DCR. A series of 25 primary En-DCR cases and their lacrimal sac specimens were involved in the study. The surgical outcomes were assessed subjectively (satisfied and unsatisfied) and objectively (successful and unsuccessful). All the specimens were examined for the chronic inflammation related histopathological features (inflammatory cell infiltration, fibrosis and capillary proliferation) and graded according to their severity. Moreover, a "chronic inflammation score" was established to determine the intensity of chronic inflammation using the grade of histopathological features. A quantitative and statistical analysis of histopathological features and chronic inflammation were performed between patients with satisfactory and unsatisfactory outcome; and patients with successful and unsuccessful outcome. The overall success rate according to subjective and objective assessment was 60%. However, 9 of 10 patients with unsatisfactory and/or unsuccessful outcome (90%) had severe chronic inflammation of lacrimal sac. In subjective assessment, inflammatory cell infiltration (p = 0.050), fibrosis (p = 0.037), capillary proliferation (p = 0.007) and chronic inflammation (p = 0.003) had a statistically significant difference between patients with satisfactory and unsatisfactory outcome. In objective assessment, statistically significant differences were detected between patients with successful and unsuccessful outcome when they compared according to inflammatory cell infiltration (p = 0.027), capillary proliferation (p = 0.007) and chronic inflammation (p = 0.003). Chronic inflammation related histopathological features of variable degree may have a role on En-DCR outcome. Chronic inflammatory score can be used as an indicator of En-DCR success.

Predictors of long‐term success and failure in primary and revision endoscopic dacryocystorhinostomy

“…Compared with external DCR, endoscopic DCR (endo‐DCR) offers the potential for less surgical trauma, shortened operative time, reduced length of hospitalization, decreased postoperative discomfort, improved cosmesis, and the ability to identify and concomitantly address sinonasal pathologies that may otherwise compromise postoperative success . The most common indications for endo‐DCR are epiphora and dacryocystitis . Endo‐DCR has demonstrated rather high rates of success, in the range of 84% to 92% for primary endo‐DCR surgeries and 66.6% to 91.3% for revision endo‐DCR surgeries .…”

“…2 The most common indications for endo-DCR are epiphora and dacryocystitis. 3 Endo-DCR has demonstrated rather high rates of success, in the range of 84% to 92% for primary endo-DCR surgeries 1 and 66.6% to 91.3% for revision endo-DCR surgeries. 4 However, there remains a subset of patients who fail endo-DCR surgeries.…”

Dacryocystorrhinostomia műtétek során eltávolított könnytömlőminták szövettani elemzése

“…Azt találták, hogy az eredménytelen, illetve elégtelen posztoperatív statussal bíró beteg esetében a könnytömlő falának lymphoid sejtes infiltrációja, fibrosisa, capillaris proliferáció jelentősen magasabb arányban fordult elő, mint a sikeres és eredményes műtétek során eltávolított könnytömlőmintákban. A szövettani vizsgálatok során általuk kialakított krónikus gyulladásos jelek rangsorolásával következtetni lehet a szerzők szerint az endoszkópos DCR-ek eredményességére [10].…”

Expression of LIGHT/TNFSF14 and Its Receptors, HVEM and LTβR, Correlates with the Severity of Fibrosis in Lacrimal Sacs from Patients with Lacrimal Duct Obstruction

“…These inflammatory infiltrations consist mainly of mononuclear cells such as macrophages and/or lymphocytes, which in some cases may form submucosal follicles and cause thickening of the lacrimal sac wall [9]. Another frequent finding is connective tissue remodeling, which in some patients leads to development of ambient fibrous tissue and scar formation [10]. Chronic tear retention and stasis may lead to secondary infection and abscess formation.…”