Evaluating failed dacryocystorhinostomy using computed tomography dacryocystography: a preliminary analysis of bony ostium characteristics in an Asian population

Xinhan Cui; Kun Shan; Xiaochun Wang; Yan Wang

doi:10.21037/qims-24-1979

Evaluating failed dacryocystorhinostomy using computed tomography dacryocystography: a preliminary analysis of bony ostium characteristics in an Asian population

Quant Imaging Med Surg. 2025 Mar 3;15(3):2183-2192. doi: 10.21037/qims-24-1979. Epub 2025 Feb 13.

Authors

Xinhan Cui^#¹, Kun Shan^#¹, Xiaochun Wang², Yan Wang¹

Affiliations

¹ Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.
² Department of Ophthalmology, Zaozhuang Municipal Hospital, Zaozhuang, China.

^# Contributed equally.

Abstract

Background: Although dacryocystorhinostomy (DCR) is the standard treatment for nasolacrimal duct obstruction, some surgeries are unsuccessful, and the reasons are not fully understood. By comparing successful and unsuccessful cases, this study investigated how computed tomography dacryocystography (CT-DCG) can help explain why these surgeries fail.

Methods: This retrospective study included 34 failed and 16 successful DCR cases. The bony ostium was analyzed using CT-DCG with 3-dimensional (3D) reconstructions. The ostium position, dimensions (width, height, total area, and shortest side), shape regularity, and presence of obstructing residual bone were measured and assessed. Preoperative nasal endoscopy was performed, and intraoperative findings were documented to supplement the CT-DCG data.

Results: Properly sized and positioned ostia were found in only 14.7% of unsuccessful cases, compared to 100% in successful cases (P<0.001). Failed cases showed higher rates of irregular ostium shapes (47.1% vs. 12.5%, P=0.019) and residual obstructing bone (70.6% vs. 6.3%, P<0.001). Through nasal endoscopy, reduced ostium visibility was detected in failed cases (32.4% vs. 93.8%, P<0.001) and higher rates of adhesions were observed (41.2% vs. 6.3%, P=0.011). Multiple contributing factors to failure were identified in 35.3% of unsuccessful cases during surgery.

Conclusions: CT-DCG provides valuable insights into ostium characteristics in failed DCR cases, including irregular ostium shape and residual obstructing bone. Although findings from nasal endoscopy and surgical observations were found to be supportive, more detailed and quantifiable information was provided by CT-DCG. These findings highlight the importance of comprehensive preoperative assessment and meticulous surgical technique in DCR procedures.

Keywords: Nasolacrimal duct obstruction (NLDO); bony ostium; computed tomography dacryocystography (CT-DCG); dacryocystorhinostomy; revision dacryocystorhinostomy (revision DCR).