Clinical Correlation of Lacrimal Sac Pathologic Findings of Lacrimal Sac from Dacryocystorhinostomy

Woo Jin Jeong; Mun Chong Hur; Mi Sook Roh; Hee Bae Ahn

doi:10.3341/jkos.2011.52.4.385

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Jeong, Hur, Roh, and Ahn: Clinical Correlation of Lacrimal Sac Pathologic Findings of Lacrimal Sac from Dacryocystorhinostomy

Original Article

J Korean Ophthalmol Soc 2011;52(4):385-391.

Published online: 6 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.4.385

Clinical Correlation of Lacrimal Sac Pathologic Findings of Lacrimal Sac from Dacryocystorhinostomy

Woo Jin Jeong, MD, PhD¹, Mun Chong Hur, MD¹, Mi Sook Roh, MD, PhD², Hee Bae Ahn, MD, PhD¹

¹Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea

²Department of Pathology, Dong-A University College of Medicine, Busan, Korea

Address reprint requests to Hee Bae Ahn, MD, PhD Department of Ophthalmology, Dong-A University Hospital #3-1 Dongdaesin-dong, Seo-gu, Busan 602-715, Korea Tel: 82-51-240-5227, Fax: 82-51-254-1987, E-mail: hbahn@dau.ac.kr

Received 15 July 20102 October 2010 Accepted 14 February 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To determine the correlation of the clinical characteristics and histopathologic findings of lacrimal sac after external dacyrocystorhinostomy (DCR).

Methods

From March 2008 to June 2009, 49 lacrimal sac tissues of 47 patients were obtained after external DCR and divided according to fibrosis and inflammatory findings. The correlation of preoperative duration of symptoms with NLD obstruction, symptoms of recurrence and outcomes of the operation to the histopathologic findings were retrospectively evaluated.

Results

The mean age of the patients was 58.83 ± 11.49 years and the mean duration of preoperative symptoms was 65.2 ± 69.05 months. Forty-three cases (88%) maintained good openings and 30 cases (61%) had no recurring symptoms over 6 months after the operation. Among the significant symptoms, severe subepithelial inflammations were observed more frequently at shorter duration. However, the fibrosis showed a positive relation with the preoperative duration of symptoms (Spearman correlation test, p<0.05). Most failures were found in the severe inflammation and fibrosis groups and were recovered with anti-inflammatory treatment.

Conclusions

Inflammation and fibrosis of the lacrimal sac could be an important prognostic and predictive factor of outcomes of DCR.

Keywords: Dacryocystorhinostomy, Fibrosis, Inflammation, Lacrimal sac histopathology

References

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Figure 1.

Histopathologic features of inflammation of lacrimal sac. (A) Mild: mild imflammatory change with loose lymphocyte ag-gregation on submucosal epithelium was found. (B) Moderated: inflammatory cell was concentrated on superior 1/2 submucosa of lacrmal sac. (C) Severe: marked inflammatory cell infiltration (mostly lymphocyte) was found all depth of submucosal epithelium (Hematoxylin & Eosin stain, ×200).

Figure 2.

Histopathologic findings of fibrosis of lacrimal sac. (A) Mild: loose fibrotic change was found on superficial submucosal epithelium. (B) Moderate: relatively thick fibrotic bundle was distributed on lacrimal submucosa. (C) Severe: dense and thick fibrosis and scarring was found (Hematoxylin & Eosin stain, ×200).

Figure 3.

Correlation analysis of the grade of inflammation for preoperative duration of symptoms (Spearman correlation, r=-0.520, p=0.001).

Figure 4.

Correlation analysis of the grade of fibrosis for preoperative duration of symptoms (Spearman correlation, r= 0.366, p=0.010).

Table 1.

Pathologic grading of inflammation & fibrosis of lacrimal sac

Grade	No. of cases
Grade	Inflammation (eye)	Fibrosis (eye)
None	8	0
Mild	11	10
Moderated	15	34
Severe	15	5

Table 2.

Postoperative outcomes according to histopathologic findings of lacrimal sac

	Postoperative symptom recurred group (19 cases)		Postoperative abnormal lacrimal irrigation group (6 cases)
	Inflammation (eye, %)	Fibrosis (eye, %)	Inflammation (eye, %)	Fibrosis (eye, %)
Mild	4 (21.05)	2 (10.5)	0 (0)	0 (0)
Moderate	4 (21.05)	14 (73.7)	0 (0)	4 (66.7)
Severe	11 (57.9)	3 (15.8)	6 (100)	2 (33.3)
Moderated to severe group	15 (78.9)	17 (89.4)	6 (100)	6 (100)

Table 3.

Mean pathologic score according to the history of dacryocystitis or cellulitis

Pathologic finding	Mean pathologic score^*		p-value
Pathologic finding	None (mean±SD, n = 42)	Presence (mean±SD, n = 7)	p-value
Inflammation	1.58 ± 1.03	3.00 ± 0.00	0.001^†
Fibrosis	1.88 ± 0.54	2.17 ± 0.75	0.227^†

^* Based on the degree of inflammation and fibrosis, 0 = none, 1 = mild, 2 = moderate, 3 = severe;

^† Kruskal-Wallis test.

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