Failed Dacryocystorhinostomy with High-Position Ostium: Insights from CT-DCG Measurements, Outcomes, and Comparison...

This study primarily aimed to identify the causes of failed dacryocystorhinostomy (DCR) with high ostium and analyze the associated radiological and endoscopic findings.

A retrospective interventional case series was conducted to analyze 72 eyes (from 69 patients) with high ostia and failed DCRs, all revised by the same surgeon between January 2015 and December 2024. The data collected included patient demographics, diagnostic and management details, objective measurements of computerized tomography dacryocystography (CT-DCG) images, and endoscopic findings. CT-DCG and endoscopy findings from 33 successful primary DCR cases were used as controls.

The most common reasons for primary DCR failure were cicatricial closure of the DCR ostium (97.2%, 70/72), and creation of a small or inappropriately positioned bony ostium. Early recurrence (at one-month post-operatively) occurred in 62.5% (45/72) of cases. Compared with the successful group, the failed group had more prior laser DCR interventions and intubations before the primary DCR surgery (p = 0.03). The failed group also had a higher incidence of associated sinusitis (p = 0.011). The distance from the superior boundary of the ostium to the frontomaxillary suture on CT-DCG was significantly variable between the cases and the controls (p = 0.003). The CT-DCG findings of inadequate bone removal overlying the lacrimal sac, the unaddressed anterior uncinate process, ostium location away from the middle turbinate axilla, and the unopened agger nasi cell appeared to be the factors that influenced the outcomes of the initial DCR (p < 0.05). At the last follow-up, the anatomical success following revision of the prior high ostium failed DCRs was achieved in 95.8% (69/72), and the outcomes were excellent.

This study provides a precise CT-DCG and endoscopic comparison between high ostium failed DCRs and the ostia of successful cases. Analysis and objective measurements of CT-DCG provided valuable insights during the revision surgery in such cohorts.