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Kim, Lee, Ham, and Yang: Surgical Outcomes of Dacryocystorhinostomy in Lacrimal Drainage Obstruction after Systemic Chemotherapy or Radioactive Iodine Therapy
Original Article

J Korean Ophthalmol Soc 2016;57(11):1684-1690.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/JKOS.2016.57.11.1684

Surgical Outcomes of Dacryocystorhinostomy in Lacrimal Drainage Obstruction after Systemic Chemotherapy or Radioactive Iodine Therapy

Dong Geun Kim, MD1, 2, Jung Jae Lee, MD1, 2, Dong Sik Ham, MD1, 2, Jae Wook Yang, MD, PhD1, 2

1Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

2T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

Address reprint requests to Jae Wook Yang, MD, PhD Department of Ophthalmology, InJe University Busan Paik Hospital, #75 Bokji-ro, Busanjin-gu, Busan 47392, Korea Tel: 82-51-890-8611, Fax: 82-51-890-8722 E-mail: oculoplasty@gmail.com

Received 30 June 2016       Revised 27 July 2016       Accepted 19 October 2016

Copyright © 2016 Korean Ophthalmological Society

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 compare the outcomes of endonasal dacryocystorhinostomy in patients with secondary lacrimal drainage obstruction associated with systemic chemotherapy or radioactive iodine therapy.

Methods

We retrospectively reviewed the clinical records of patients diagnosed with secondary lacrimal drainage obstruction after systemic chemotherapy or radioactive iodine therapy for thyroid disease and surgical treatment by endonasal dacryocystorhinostomy between January 2009 and January 2015. The control group included randomly selected patients who underwent endonasal dacryocystorhinostomy after diagnosis of primary lacrimal drainage obstruction.

Results

Patients were separated into a chemotherapy group (13 eyes of 9 patients), a radioactive iodine therapy group (44 eyes of 32 patients), and a control group (50 eyes of 40 patients). Duration from the onset of systemic chemotherapy or radioactive iodine to the first epiphora symptom was shorter in the chemotherapy group than the radioactive iodine therapy group (p < 0.001). There was no significant difference between the three groups in success rate of endonasal dacryocystorhinostomy.

Conclusions

Most patients with secondary lacrimal drainage obstruction associated with systemic chemotherapy or radioactive iodine therapy had successful outcome of endonasal dacryocystorhinostomy. The success rate of dacryocystorhinostomy was comparable to that in patients with primary lacrimal drainage obstruction.

Keywords: Chemotherapy, Dacryocystorhinostomy, Radioactive iodine, Secondary lacrimal drainage obstruction

References

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Table 1.
Munk's score
Grade Symptom
0 No epiphora
1 Occasional epiphora requiring dabbing less than twice a day
2 Epiphora requiring dabbing 2–4 times per day
3 Epiphora requiring dabbing 5–10 times per day
4 Epiphora requiring dabbing more than 10 times per day
5 Constant tearing
Table 2.
Details of chemotherapy group patients' antineoplastic therapies and ophthalmologic diagnoses
Patient Sex/ no. Age Diagnosed cancer Chemotherapy regimeny Chemotherapy cycles before the epiphora Epiphora from first chemotherapy Obstruction site
1 F/71 Breast cancer TAC* 3 cycles (every 3 weeks) 3 months Left complete NLD obstruction
2 F/70 Breast cancer TAC 4 cycles (every 3 weeks) 4 months Right complete NLD obstruction
            Right inferior canalicular stenosis
3 F/50 Breast cancer FEC† 3 cycles (every 4 weeks) 3 months Bilateral complete NLD obstruction
4 M/59 Gastric cancer S S-1, cisplatin 4 cycles (every 4 weeks) 6 months Bilateral complete NLD obstruction
            Right inferior canalicular stenosis
5 F/49 Breast cancer FAC‡ 3 cycles (every 4 weeks) 3 months Left common canalicular stenosis
6 F/61 Breast cancer TAC 2 cycles (every 3 weeks) 2 months Bilateral partial NLD obstruction
7 M/54 Gastric cancer S S-1, cisplatin 2 cycles (every 4 weeks) 3 months Left complete NLD obstruction
8 F/43 Breast cancer TAC 6 cycles (every 3 weeks) 6 months Bilateral complete NLD obstruction
9 M/68 Gastric cancer S S-1, cisplatin 5 cycles (every 2 weeks) 8 months Right complete NLD obstruction

NLD = nasolacrimal duct.

* Docetaxel + doxorubicin + cyclophosphamide

† Cyclophosphamide + epirubicin + 5-fluorouracil

‡ Cyclophosphamide + doxorubicin + 5-fluorouracil.

Table 3.
Details of radioactive iodine group patients' therapies and ophthalmologic diagnoses
Patient no. Sex/Age Diagnosis 131 I dose (mCi) Epiphora from first radio aoactive iodine therapy (months) Obstruction site
1 F/55 PTC (T4N0M0) 300 12 Left complete NLD obstruction
2 F/63 PTC (T3N1M0) 180 16 Right complete NLD obstruction
3 F/57 PTC (T4N0M0) 150 8 Right complete NLD obstruction
          Left partial NLD obstruction
4 F/60 PTC (T3N1M0) 200 12 Bilateral complete NLD obstruction
          Left common canalicular stenosis
5 M/56 PTC (T3N1M1) 180 6 Right complete NLD obstruction
6 F/62 PTC (T2N0M1) 400 8 Bilateral partial NLD obstruction
          Right inferior canalicular stenosis
7 F/54 PTC (T4N0M0) 200 10 Left complete NLD obstruction
8 F/52 PTC (T2N1M0) 180 14 Right complete NLD obstruction
9 F/61 PTC (T4N0M0) 450 16 Bilateral complete NLD obstruction
10 M/70 PTC (T3N1M0) 250 12 Left common canalicular stenosis
11 F/57 PTC (T2N1M1) 150 12 Right complete NLD obstruction
12 F/58 PTC (T3N1M0) 200 12 Right complete NLD obstruction
13 F/57 PTC (T4N0M1) 300 12 Right complete NLD obstruction
          Right inferior canalicular stenosis
14 F/50 PTC (T3N1M0) 150 16 Bilateral complete NLD obstruction
15 F/59 PTC (T3N1M1) 150 18 Left complete NLD obstruction
          Left common canalicular stenosis
16 F/51 PTC (T3N1M0) 250 18 Bilateral complete NLD obstruction
17 F/52 PTC (T2N1M0) 200 12 Right common canalicular stenosis
18 F/52 PTC (T3N1M0) 300 12 Left complete NLD obstruction
          Left superior canalicular stenosis
19 F/58 PTC (T2N0M1) 300 12 Right complete NLD obstruction
20 F/55 PTC (T3N1M1) 450 18 Bilateral partial NLD obstruction
21 F/65 PTC (T3N1M0) 300 18 Bilateral complete NLD obstruction
          Left common canalicular stenosis
22 F/52 PTC (T4N0M1) 180 24 Bilateral complete NLD obstruction
23 F/52 PTC (T4N0M0) 300 8 Left complete NLD obstruction
24 F/48 PTC (T2N1M0) 150 6 Right complete NLD obstruction
25 F/54 PTC (T3N1M0) 150 12 Right complete NLD obstruction
26 F/69 PTC (T2N1M1) 200 12 Left partial NLD obstruction
          Left inferior canalicular stenosis
27 F/49 PTC (T3N1M1) 180 8 Right common canalicular stenosis
28 F/55 PTC (T3N1M1) 300 12 Bilateral complete NLD obstruction
29 F/63 PTC (T3N1M0) 300 18 Right complete NLD obstruction
30 F/55 PTC (T3N1M0) 180 18 Left complete NLD obstruction
31 F/57 PTC (T4N0M1) 400 14 Bilateral complete NLD obstruction
32 F/47 PTC (T2N1M1) 150 12 Bilateral complete NLD obstruction

131 I = radioactive iodine 131; mCi = millicurie; PTC = papillary thyroid cancer; NLD = nasolacrimal duct.

Table 4.
Baseline characteristics of patients in three groups
  Chemotherapy group (9 patients) RI group (32 patients) Control group (40 patients) p-value
Age (years) 58.3 ± 10.1 56.4 ± 5.6 59.3 ± 8.3 eye 0.289*
Female number (%) 6 (66.7) 30 (93.8) 35 (87.5) 0.092†
Bilateral:unilateral (%) 4:5 (44.4) 12:20 (37.5) 10:30 (25.0) 0.371†
Onset from first treatment (months s) 4.22 ± 1.99 13.06 ± 4.10   <0.001‡

Values are presented as mean ± SD or n (%) unless otherwise indicated. RI = radioactive iodine.

* One way analysis of variance (ANOVA) test

† Chi-square test

‡ Independent t-test.

Table 5.
Surgical outcomes of endonasal dacryocystorhinostomy in three groups
  Chemotherapy group (13 eyes) RI group (44 eyes) Control group (50 eyes) p-value
Success at 6 month 11/13 (84.6%) 40/44 (90.9%) 47/50 (94.0%) 0.542*
Complications        
 Granuloma formation 3/13 (23.1%) 11/44 (25.0%) 9/50 (18.0%) 0.211*
 Synechiae 1/13 (7.7%) 2/44 (4.5%) 3/50 (6.0%) 0.372*
Revision surgery 1/13 (7.7%) 3/44 (6.8%) 3/50 (6.0%) 0.972*

RI = radioactive iodine.

* Chi-square test.

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