The FICI grading for a dacryocystorhinostomy ostium

Abstract

Purpose: The objective of this study is to propose a simple grading to assess the health of a dacryocystorhinostomy (DCR) ostium. Methods: Prospective case series of 237 Ostia evaluated following dacryocystorhinostomy were included in the study. All the ostia were assessed for 10 parameters in detail using the earlier published DCR ostium scoring (DOS scoring). Each of the 10 parameters were scored individually, and final DOS scores were obtained. The anatomical and functional outcomes of each of the surgery were noted. The most significant parameters that influenced the success were determined using the binary recursive partitioning in a conditional inference framework. Data management and statistical tests were performed using the statistical “Software R” and the library “partykit” toolkits. Results: The most significant DCR ostium parameters that influenced the outcomes were anatomical and functional fluorescein dye transit ( p < 0.001), dynamicity of internal common opening (ICO) on the blink ( p < 0.001), end-on threats to ICO from granuloma, membrane or a synechia, and cicatricial closure of the Ostia. Each of these significant factors (FICI – Fluorescein endoscopy dye test, ICO dynamicity, Cicatricial ostium closure and ICO threats) were assigned simple scoring and the final scores were graded from 0 (poor DCR ostium) to +5 (excellent DCR ostium). FICI grading can guide the physician on the health status of the DCR ostium and the possible need for intervention. Conclusion: FICI DCR ostium grading is a simple, easy to perform, and physician-friendly system. More studies with larger sample size would help in further validating the FICI grading.

Prospective, randomised clinical trial on the necessity of using a silicone intubarium in the context of endonasal-endoscopic dacryocystorhinostomy (EN-DCR) in patients with postsaccal lacrimal duct stenosis

“…The more recently introduced FICI grading system by Ali et al is a good start to standardize postoperative measurements and can help to improve the comparability of different studies. FICI is a simple and physician-friendly scoring and grading system to assess the health of a DCR ostium and makes it particularly easy to evaluate the postoperative healing progress [ 33 ].…”

Prognosis of concurrent endoscopic dacryocystorhinostomy and nasal septoplasty for chronic dacryocystitis with moderate nasal septum deviation

“…This simple and physician-friendly tool uses four parameters optimized from the 10 parameters for earlier DCR ostium (DOS) scoring. [ 13 31 ] The final score determined the ostium grade, which served as a guide for intervention. Notably, only 6.3% of patients in the septoplasty group required definitive postoperative intervention, a proportion comparable to that of the En-DCR alone group.…”

“…The primary outcome was surgical success, as assessed using DCR ostium score (0–5) and grade (poor, good, and excellent). According to the FICI DCR ostium grading score system,[ 13 ] DCR ostium score is the total score for the four ostial parameters that influence the anatomical and functional outcomes of DCR surgery. The first parameter is the FEDT score (range 0–2); the scores were 2 for spontaneous FEDT, 1 for non-spontaneous but positive with irrigation, and 0 for negative and non-patency with irrigation.…”

“…The FICI grades were classified as excellent (score of 5, no intervention needed), good (score of 3–4, minimal intervention needed), and poor (score of 0–1, definitive intervention and corrective measures needed). [ 13 ]…”