Long-term efficacy and safety of steroid-eluting sinonasal stents in endoscopic dacryocystorhinostomy: a prospective, single-arm study.

BACKGROUND: Chronic dacryocystitis resulting from lacrimal pathway obstruction is a persistent condition associated with bothersome symptoms. OBJECTIVE: This study aimed to evaluate the long-term efficacy and safety of steroid-eluting sinus stents in endoscopic dacryocystorhinostomy (EN-DCR). METHODS: This study enrolled patients who underwent EN-DCR between July 2021 and April 2022. Adult patients with chronic dacryocystitis caused by primary lacrimal duct obstruction were enrolled. After completion of the conventional EN-DCR procedure, a steroid-eluting sinus stent designed for use in the frontal sinus was implanted at the ostium. Patients were followed up for 54 months after surgery. Operative time, stent removal time, and symptoms at each follow-up visit were recorded. The endoscopic ostium patency rate and lacrimal irrigation success rate were analyzed using the Kaplan-Meier product-limit survival analysis. RESULTS: A total of 31 patients (33 eyes) were included. At 12, 45 and 54 months, the neo-ostial patency rates were 96.97% (95% confidence interval [CI] 80.37%-99.57%), 93.94% (95% CI 77.88%-98.45%) and 90.70% (95% CI 73.84%-96.91%), with 3 eyes experiencing ostial occlusion over 54 months. Lacrimal irrigation success rates matched patency rates at 12 and 45 months (96.97% and 93.94%, identical 95% CIs), declining to 84.22% (95% CI 66.12%-93.12%) at 54 months in 5 eyes with irrigation failure. Serum cortisol concentrations stayed within normal range, with no stents-related adverse events documented postoperatively. CONCLUSIONS: Implantation of steroid-eluting sinonasal stents during EN-DCR achieves favorable long-term safety and efficacy by preserving neo-ostial patency. Nevertheless, dedicated stents anatomically tailored to the neo-ostium of EN-DCR are required to further optimize surgical outcomes.