title: Histopathologic changes in the lacrimal sac of dacryocystorhinostomy patients with and without silicone intubation.
abstract: OBJECTIVE
  To evaluate the histopathologic impact of dacryocystorhinostomy (DCR) and silicone intubation on the lacrimal sac.
  
  
  METHODS
  Biopsy materials were taken from the sac wall and fixed (primary biopsy) in 224 patients undergoing DCR between 1995 and 2003 in our institution. A total of 23 patients underwent a second operation as the result of restenosis, and a secondary biopsy specimen was taken from the sac wall. During the initial operation, DCR and silicone intubation were combined in 13 patients (group 1), and only DCR without silicone intubation was performed in 10% patients (group 2). The histopathologic findings of the primary and secondary biopsy specimens were compared in these 23 recurrent cases. In addition, the secondary biopsy findings in the intubation and nonintubation groups were compared to determine the possible effects of the silicone intubation on the sac mucosa.
  
  
  RESULTS
  Endonasal examination of restenosis cases revealed macroscopic cicatrization. One of the cases with silicone intubation had pyogenic granuloma and two had polypoid granulation tissue at the site of anastomosis. Inflammatory polypoid development at the site of anastomosis was also observed in one case without intubation. The primary biopsy specimens of those 23 patients undergoing a second operation revealed the following findings: chronic inflammatory changes, mild fibrosis, focal ulceration in the epithelium, and a decrease in the number of goblet cells. In the secondary biopsy specimens, 2 patients in group 1 had polypoid granulation tissue, 1 patient had pyogenic granuloma, and 3 patients had exudate reflecting acute inflammation. In group 2, granulation tissue was observed in 1 case, and 2 patients had acute inflammation. There were no differences in the primary and secondary biopsy specimens of the two groups with respect to chronic inflammatory changes, focal ulceration, and the number of goblet cells (p = 0.31; 0.31, 0.65). A marked increase in fibrosis was observed in the secondary biopsy specimens of all cases (p < 0.0001). There were no significant differences between the intubation and the nonintubation groups in terms of secondary biopsy specimens (p > 0.05).
  
  
  CONCLUSIONS
  The marked increase in the intensity of fibrosis observed in the secondary biopsy specimens of all cases was the result of the tissue repair reaction against surgical manipulation rather than the effect of the silicone tube.
authors.affiliation: Department of Ophthalmology, Gulhane Military Medical Academy, Istanbul, Turkey. ciftciferda@yahoo.com
authors.forename: Ferda
authors.initials: F
authors.lastname: Ciftci
authors.forename: Dilaver
authors.initials: D
authors.lastname: Erşanli
authors.forename: Levent
authors.initials: L
authors.lastname: Civelek
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Baloglu
authors.forename: Koray
authors.initials: K
authors.lastname: Karadayi
authors.forename: Atilla
authors.initials: A
authors.lastname: Güngör
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D003608:Dacryocystorhinostomy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007440:Intubation / Q000295:instrumentation*; D007765:Lacrimal Apparatus / Q000473:pathology* / Q000601:surgery; D007767:Lacrimal Duct Obstruction / Q000473:pathology; D008875:Middle Aged; D009297:Nasal Mucosa / Q000473:pathology; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods; D012008:Recurrence; D012086:Reoperation; D012826:Silicone Elastomers
chemical_list: D012826:Silicone Elastomers