Impact of Preoperative Lacrimal Sac Morphology on Postoperative Rhinostomy Shape and Prognosis in Endoscopic Dacryocystorhinostomy.

PURPOSE

To determine the association between the preoperative shape of the lacrimal sac and the postoperative shape of a rhinostomy in patients undergoing endoscopic dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction.

MATERIAL AND METHODS

This retrospective study involved 180 cases among 129 patients. Preoperative dacryocystography (DCG) classified lacrimal sacs into constricted or cylindrical types based on their width relative to the nasolacrimal duct. Postoperative rhinostomy shapes were categorized into flat, ladle, and ice-scoop types according to the presence and visibility of borders between the lacrimal sac and nasal mucosa. Anatomic success required patency as verified by syringing, whereas functional success required the complete resolution of epiphora.

RESULTS

The 180 cases comprised 46 (25.7%) and 134 (74.3%) classified as constricted and cylindrical preoperative shapes, respectively. There were 24 flat, 92 ladle, and 64 ice-scoop types of rhinostomies observed postoperatively. The preoperative DCG shape influenced the postoperative rhinostomy shape, with constricted sacs more frequently resulting in flat-shaped rhinostomies, and cylindrical sacs more frequently resulting in ice-scoop-shaped rhinostomies. Functional success was more common in cylindrical and ladle-type sacs than in constricted types ( P <0.001), and lower for flat-shaped rhinostomy than for the ladle and ice-scoop shapes ( P =0.003).

CONCLUSIONS

Lacrimal sac characteristics play a prominent role in determining the postoperative rhinostomy shape that is particularly relevant to functional outcomes. A preoperative cylindrical lacrimal sac and postoperative ice-scoop-shaped rhinostomy are predictive of functional success after endoscopic DCR. These observations will be crucial in creating a surgical plan and monitoring the postoperative rhinostomy configuration.