Analysis of the effectiveness of dacryocystorhinostomy with a counteropening in the treatment of secondary nasolacrimal duct obstruction

Relevance Secondary obliteration of the lacrimal ducts is one of the complications in patients after high-dose radioiodine therapy for thyroid cancer [1]. The clinical effectiveness of dacryocystorhinostomy (DCR) in such patients is slightly lower than after a similar operation for primary obliteration of the lacrimal ducts, which is associated with both the possible development of sump syndrome and the peculiarity of the localization of obliteration in the distal part of the nasolacrimal duct [2, 3]. To increase the effectiveness of DCR, the imposition of a counter-opening during surgery was proposed [4]. Objective To analyze the clinical effectiveness of DCR with the imposition of a counter-opening in secondary obliteration of the lacrimal ducts. Material and methods The study included 49 patients (49 cases) with nasolacrimal duct obliteration after radioiodine therapy for thyroid cancer aged 18 to 73 years (mean age 43 ± 16 years), including 9 men and 40 women. In 15 cases, modified endonasal endoscopic DCR according to Wormald with counter-opening was performed, and in 34 cases, a similar operation without it. Postoperative management was identical in both groups of patients. The follow-up period for patients was at least six months. Results Analysis of the study results showed that DCR with counter-opening was effective in 100% of cases (15 patients) and in 88% of cases (30 patients) in the control group in all patients. Conclusion Despite the fact that statistical analysis did not reveal a reliable difference in the clinical effectiveness of DCR depending on its variant, a tendency towards a relative increase in the effectiveness of DCR with the imposition of a counter-aperture can be noted. Considering that the proposed operation has shown its absolute effectiveness in patients with secondary obliteration of the lacrimal ducts after radioiodine therapy, its use can be recommended in patients with primary obliteration of the lacrimal ducts at the level of the nasolacrimal duct orifice. Keywords: lacrimal ducts; dacryocystorhinostomy; radioiodine therapy