Efficacy of endoscopic dacryocystorhinostomy for the treatment of nasolacrimal duct obstruction secondary to high dose radioactive iodine ablation
What:
Paper Presentation | Présentation d'article
Part of:
When:
1:36 PM, Friday 1 Jun 2018
(6 minutes)
Where:
Metro Toronto Convention Centre (South Building)
- Room 714 A
How:
Authors: Rafic Antonios, Francois Codère
Author Disclosure Block: R. Antonios: None. F. Codère: None.
Abstract Body:
Purpose: To evaluates the efficacy of endoscopic dacryocystorhinostomy (eDCR) for nasolacrimal duct obstruction (NLDO) in patients exposed to radioactive iodine (RAI) for treatment of thyroid carcinoma.
Study Design: Retrospective consecutive chart review.
Methods: A consecutive chart review of all patients who had received RAI for the treatment of thyroid carcinoma and had undergone eDCR as the primary procedure for the treatment of NLDO, from January 2007 to December 2016 at, was conducted. All patients had surgery performed by the same surgeon F.C, had undergone probing and irrigation to assess NLDO preoperatively and at 1 week, 1 month, and 3 months postoperatively. All patients had silicone tubes removed after 4-6 weeks postoperatively. Mitomycin C (MMC) was only used in redo DCR surgeries. At baseline no patient had any concomitant obstruction arising from sites other than the nasolacrimal duct, any eyelid or eyelash abnormalities, or any prior interventions to the lacrimal system, and none had a history of facial trauma or fractures of the nose and orbital walls.
Results: A total of 18 of 354 patients (5%) were treated with high dose RAI therapy for thyroid carcinoma prior to onset of NLDO and intervention with eDCR. All of the patients were females with a mean age of 50 ± 15 years (range: 20-72 years). The mean RAI dose was 239 ± 105 mCi. DCR was performed bilaterally in 10 patients and unilaterally in 8 patients. After one surgery, complete recovery was obtained in 10 (56%) patients, and partial relief was obtained in 8 (44%) patients. Among the 8 patients that had persistent epiphora, 3 patients refused additional surgery, 1 patient successfully underwent external DCR with MMC, and 2 of 4 (50%) had successful revision eDCR with MMC. At the time of revision surgery, all patients had scarring and epithelialization either at the level of the ostium, or around the internal punctum. Among patients who were found to fail initial eDCR in our study, patients that had previously received high dose RAI for the treatment of thyroid carcinoma constituted 8 of 23 (35%). Overall success rate of primary eDCR increased from 93% to 96% when patients who had previously received high dose RAI for thyroid carcinoma are excluded.
Conclusions: RAI-associated NLDO is associated with a higher incididence of eDCR surgery failure. Use of MMC in revision eDCR might be associated with an increased chance of success.
Author Disclosure Block: R. Antonios: None. F. Codère: None.
Abstract Body:
Purpose: To evaluates the efficacy of endoscopic dacryocystorhinostomy (eDCR) for nasolacrimal duct obstruction (NLDO) in patients exposed to radioactive iodine (RAI) for treatment of thyroid carcinoma.
Study Design: Retrospective consecutive chart review.
Methods: A consecutive chart review of all patients who had received RAI for the treatment of thyroid carcinoma and had undergone eDCR as the primary procedure for the treatment of NLDO, from January 2007 to December 2016 at, was conducted. All patients had surgery performed by the same surgeon F.C, had undergone probing and irrigation to assess NLDO preoperatively and at 1 week, 1 month, and 3 months postoperatively. All patients had silicone tubes removed after 4-6 weeks postoperatively. Mitomycin C (MMC) was only used in redo DCR surgeries. At baseline no patient had any concomitant obstruction arising from sites other than the nasolacrimal duct, any eyelid or eyelash abnormalities, or any prior interventions to the lacrimal system, and none had a history of facial trauma or fractures of the nose and orbital walls.
Results: A total of 18 of 354 patients (5%) were treated with high dose RAI therapy for thyroid carcinoma prior to onset of NLDO and intervention with eDCR. All of the patients were females with a mean age of 50 ± 15 years (range: 20-72 years). The mean RAI dose was 239 ± 105 mCi. DCR was performed bilaterally in 10 patients and unilaterally in 8 patients. After one surgery, complete recovery was obtained in 10 (56%) patients, and partial relief was obtained in 8 (44%) patients. Among the 8 patients that had persistent epiphora, 3 patients refused additional surgery, 1 patient successfully underwent external DCR with MMC, and 2 of 4 (50%) had successful revision eDCR with MMC. At the time of revision surgery, all patients had scarring and epithelialization either at the level of the ostium, or around the internal punctum. Among patients who were found to fail initial eDCR in our study, patients that had previously received high dose RAI for the treatment of thyroid carcinoma constituted 8 of 23 (35%). Overall success rate of primary eDCR increased from 93% to 96% when patients who had previously received high dose RAI for thyroid carcinoma are excluded.
Conclusions: RAI-associated NLDO is associated with a higher incididence of eDCR surgery failure. Use of MMC in revision eDCR might be associated with an increased chance of success.
