Abstract Listings 2024

Purpose

Granulomatosis with polyangiitis (GPA) is a rare systemic vasculitis which commonly affects the upper respiratory tract and can cause chronic intranasal inflammation with resultant nasolacrimal duct obstruction. We present the outcomes of dacryocystorhinostomy surgery (DCR) in GPA patients at our hospital.

Methods

In this retrospective study, GPA patients who underwent DCR over an 11-year period were identified from the hospital’s electronic database. Lacrimal symptoms, pre-operative immunosuppression, perioperative medical management, resolution of symptoms, and need for further surgical intervention were recorded.

Results

16 patients were identified over the study period (2009-2020). 5 patients underwent bilateral surgery; therefore, DCR was performed on 21 eyes in this cohort. A lacrimal sac mucocoele was present in 71% of cases and the majority (86%) were on systemic immunosuppression at the time of surgery. In addition, 20 of the 21 procedures (95%) were completed with per-operative intravenous steroid cover; 15 out of 16 patients had a post-operative course of oral prednisolone. Mean duration of follow up was 20 months (range 2-70 months). 90% (19/21) of DCRs were functioning at final follow up. 10% (2/21) had functional failure, although anatomical success was noted on nasal endoscopy. One patient, who had previous rhinoplasty, suffered recurrent nasal collapse following DCR, requiring rhinoplasty revision.

Conclusion

DCR surgery can be successfully performed in GPA patients whose systemic disease is adequately controlled. Patients should be counselled about the increased risk of DCR failure due to chronic intranasal inflammation. Perioperative systemic steroids are essential to prevent DCR failure. Nasal collapse, which is a feature of GPA, may also worsen after DCR.

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