Results of combined surgical treatment in chronic purulent dacryocystitis

Purpose. The purpose of this study was to compare the results of the standard technique of transcanalicular laser endoscopic dacryocystorinostomy with the proposed method of combined surgical treatment in chronic purulent dacryocystitis. Material and methods. 27 patients with chronic purulent dacryocystitis were under observation. All patients were examined by standard ophthalmological methods. In addition, the following procedures were performed: evaluation of lacrimation severity according to the Munk scale, lacrimal tract lavage, cone beam computed tomography with contrast. In all patients, preoperative lacrimation according to the Munk scale was 3–4 points (with a norm of 0 points). Contrast delay in the nasolacrimal duct at the exit level into the lower nasal passage was observed on CBT images in patients of both groups. Patients were randomly divided into two groups. In the main group (15 patients, 15 eyes) TLED was performed, supplemented by nasolacrimal duct probing with temporary insertion of a Monoka silicone stent (FCI, France) and its fixation in the lower nasal passage. The control group (12 patients, 12 eyes) underwent standard TLED with temporary insertion of a Monoka silicone stent (FCI, France) through a dacryostomy and fixation of the stent in the middle nasal passage. The surgeries were uneventful in all groups. The follow-up period was 6 months. Statistical processing of the obtained data was carried out using the IBM SPSS Statistics v.21 program. Results and discussion. Patients were examined postoperatively on days 2 and 7 and then at 1, 3 and 6 months for dynamic follow-up. All patients underwent a standard ophthalmological examination. Lacrimation according to the Munk scale in both groups was 0 points after surgery. However, in 5 (41.6%) patients of the control group, lacrimation according to the Munk scale corresponded to – 2 points. Of these, 2 patients had lacrimation 1 month after surgery, and 3 patients had lacrimation 6 months after surgery. The flushing test was positive in all patients of both groups. However, in the control group, the flushing test was partially positive (in 2 patients – after 1 month, in 3 patients – at the 6th month). Silicone stents were removed 6 months after surgery, followed by contrast-enhanced CBCT. In the CBCT images of the main group, the contrast agent was visible only in the nasal cavity in 100% of cases. Whereas in the control group, only 7 (58.4%) patients had a contrast agent detected in the nasal cavity, while the remaining 5 (41.6%) patients had a delay in the nasolacrimal duct. In the main group, 100% of patients had a positive result after surgery. Whereas in the control group, the result of surgical treatment was positive only in 58.4% of cases (in 7 patients). In 41.6% (5) patients, the result was partially achieved. Conclusion. The proposed method of surgical treatment in chronic purulent dacryocystitis is more effective, physiological, and can be recommended for the surgical treatment of patients with contrast agent retention in the nasolacrimal duct at the level of its exit into the lower nasal passage. Key words: dacryocystitis, cone beam computed tomography, contrast solution, transcanalytical laser-assisted endoscopic dacryocystorinostomy, silicone stent