Dacryoscintigraphy as a guide for surgery in patients with functional epiphora
Authors: Victoria Leung 1, Mikaël Bernier2, Amanda Miller3, M Reza Vagefi3, Robert Kersten3, Evan Kalin-Hajdu4. 1William Osler Health System, 2Université de Montréal, 3University of California, San Francisco, 4Univeristé de Montréal.
Author Disclosures: V. Leung: None. M. Bernier: None. A. Miller: None. M. Vagefi: None. R. Kersten: None. E. Kalin-Hajdu: None.
Abstract Body:
Purpose: To investigate the role of dacryoscintigraphy (DSG) in surgical planning for functional epiphora.
Study Design: Retrospective multi-centered case series
Methods: This study adhered to the World Medical Association’s ethical principles for medical research involving human subjects as outlined in the Declaration of Helsinki. Institutional Review Board (IRB) approval was obtained at Université de Montréal (2020-2234) and University of California San Francisco (20-30299). Patients with symptomatic tearing despite no identified external cause and normal lacrimal probing and irrigation (i.e., functional epiphora) were included. All patients had preoperative DSG testing. Patients were excluded if DSG testing failed to detect a tear flow abnormality. Those with delayed tear flow prior to entering the lacrimal sac (pre-sac) on DSG underwent surgery aimed at improving flow into the lacrimal sac. Those with delayed tear flow after the lacrimal sac (post-sac) on DSG underwent dacryocystorhinostomy (DCR). Surgical success was defined as epiphora being completely resolved, significantly improved, or partially improved. Surgical failure was defined as epiphora being unchanged or worse when compared to the preoperative timepoint.
Results: 77 cases (53 patients) underwent DSG-guided surgery. Twenty-four cases (31.2%) had undergone previous periocular or lacrimal surgery that failed to improve epiphora. A pre-sac delay was observed in 14 cases (18.2%) and post-sac delay in 63 (81.8%). Overall surgical success was 83.1% (64 of 77 cases) across the cohort. Success was 100% in the pre-sac group and 79.4% in the post-sac group (p = 0.06). In cases with previously failed surgery, overall success was 70.8% (5 of 5 in the pre-sac group, 12 of 19 in the post-sac group). In cases without prior surgery, overall success was 88.7% (9 of 9 in the pre-sac group, 38 of 44 in the post-sac group). The difference in success between those with and without previous surgery neared statistical significance (p = 0.06). The mean follow-up time was 22 months.
Conclusions: A role was demonstrated for DSG in the planning of surgery for patients with functional epiphora. The DSG-guided approach, when compared to empiric lacrimal intubation or DCR, may be most beneficial in cases of functional epiphora that is pre-sac in nature.
