Routine histopathologic evaluation of the lacrimal sac during dacryocystorhinostomy: how useful is it?
Section snippets
Materials and methods
Three hundred two lacrimal sac biopsies obtained from 258 patients (44 bilateral cases) who underwent DCR for presumed primary acquired NLDO from 1988 through 1999 at the University of Cincinnati- and Cincinnati Eye Institute-affiliated facilities were reviewed retrospectively. Preoperative assessment of the lacrimal drainage system included history for predisposing conditions, inspection, palpation, digital expression of lacrimal sac contents, dye disappearance test with 2% fluorescein, and
Results
A total of 302 DCRs were performed for acquired NLDO on 258 patients. Of these 258 patients, 170 (66%) were females and 88 (34%) were males, with an average age of 61.3 years (range, 10–95 years). Twenty-two patients had bilateral surgery and 236 had unilateral surgery. Dacryocystitis was present in 91 patients (30%) in either acute or chronic form. History of nasal trauma was present in 19 patients (6.3%).
The patients were divided into two groups on the basis of history and clinical
Discussion
The incidence of unsuspected lacrimal sac pathologic features at the time of DCR has been reported to be between 0% and 12.5%. Several authors have recommended that routine histopathologic evaluation of the lacrimal sac be performed in all patients undergoing surgery to correct primary acquired NLDO. However, routine histopathologic evaluation is expensive, with surgical pathologic charges ranging from $250 to $480 for each surgical specimen reviewed in this study.
Bartley,4, 5, 6 in his
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