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Ostium shrinkage after endoscopic dacryocystorhinostomy.

Research paper by WengOnn W Chan, Dinesh D Selva

Indexed on: 07 May '13Published on: 07 May '13Published in: Ophthalmology



Abstract

Ostium closure after endoscopic dacryocystorhinostomy (DCR) is the commonest cause for anatomic failure. We aimed to determine the changes in size of the DCR ostium over time and investigate the correlation of ostium size and surgical outcomes.A single surgeon, prospective, nonrandomized, noncomparative, interventional case series.We included a consecutive series of patients who underwent powered endonasal DCR. All patients had radiologically confirmed nasolacrimal duct or canalicular obstruction.Patients were operated on by 1 surgeon (D.S.) and follow-up was at 4 weeks and 12 months. Ostium sizes were measured at the end of surgery and at 4 weeks and 12 months after surgery.Intraoperative and postoperative ostium size, correlation of ostium size, and surgical outcome.We included 161 patients who fulfilled the inclusion criteria. Three patients were lost to follow-up. The ostium measured 8.6 (95% confidence interval [CI], 5.0-12.2) by 13.4 (95% CI, 10.3-16.5) at the time of surgery and 5.7 (95% CI, 2.3-9.0) by 9.5 (95% CI, 6.0-13.0) at 4 weeks, and 4.8 (95% CI, 1.9-7.7) by 8.2 (95% CI, 4.5-11.9) at 12 months. There was significant ostial shrinkage from surgery to 4 weeks (mean shrinkage of 50%) and from 4 weeks to 12 months (mean shrinkage of a further 15%). The intraoperative ostium size and postoperative size were positively correlated. Ostial size was not predictive of final ostial patency and symptomatic resolution of epiphora.After endoscopic DCR, the final ostium size on average is 35% of the original at 12 months postoperatively. The majority of the ostium shrinkage occurs within 4 weeks postoperatively with a lesser degree of shrinkage between 1 and 12 months postoperatively. Ostium size was not predictive of overall surgical outcome.The authors have no proprietary or commercial interest in any of the materials discussed in this article.