Clinical -to- Pathological Correlation of Lacrimal Sac Specimens Obtained During Dacryocystorhinostomy Surgery

Abstract

Purpose: To correlate the clinical data to the histopathological characteristics of lacrimal sac and bone specimens in adult patients undergoing indicated external transcutaneous dacryocystorhinostomy surgery (DCR) for primary acquired nasolacrimal duct obstruction (PANDO) in order to determine the important clinical parameters that may necessitate selective lacrimal biopsy in certain situations.Methods: This is non-comparative, non-controlled descriptive case series study with histopathological correlation. Lacrimal sac and bone specimens for each case were collected during DCR from consecutive patients with PANDO presenting to the outpatient clinic of “Ain Shams University” hospitals, then sent for histopathological examination.Results: Fifty-one lacrimal specimens were obtained from a total of 49 consecutive patients who underwent external DCR for clinical PANDO at the time interval from March 2018 to March 2020 at “Department of Ophthalmology, Ain Shams University” operating theatre. The mean patients' age was 44.82± 13.63 years (range 21- 75). Among the 49 patients recruited, 6 (12.2%) were males and 43 (87.8%) were females. Non -specific lacrimal sac pathology was present in all 51 samples (3.9% acute inflammation and 96.1% chronic non-specific inflammation). Of the chronic non-specific inflammation specimens, mild degree of inflammation was seen in 40.8%, 44.9% showed moderate chronic inflammation, whereas only 14.3% showed severe inflammatory changes. The only two clinical parameters that were strongly correlated with the severity of inflammation are the intraoperative appearance of the sac and the presence of a lacrimal fistula with P-value (