J Korean Ophthalmol Soc.  2014 May;55(5):633-639. 10.3341/jkos.2014.55.5.633.

Analysis of the Results Endonasal Dacryocystorhinostomy Related to Nasal Cavity State

• Baek SK
• Ha MS

• KMID: 2218082
• DOI: http://doi.org/10.3341/jkos.2014.55.5.633

Abstract

PURPOSE
This study evaluated the relationship of nasal cavity state and surgical results after endonasal dacryocystorhinostomy (DCR).
METHODS
We retrospectively analyzed 306 eyes of 204 patients between January 2007 and December 2011. The correlation between the existence of preoperative nasal cavity abnormality, postoperative nasal cavity complications after proper management of nasal cavity abnormality, and postoperative nasal cavity complications according to nasal packing material were investigated. We analyzed the success rates and the correlation between each set of factors.
RESULTS
The success rate of primary operations performed six months after tube removal was 87.3% (267/306). The success rate after secondary revision, granuloma removal and punctoplasty was 90.5% (277/306). Postoperative nasal cavity complications were inspected in 40 eyes. Of the 306 eyes, patients treated with Nasopore showed significantly more postoperative nasal cavity complications (47.8%, 32/67) than in patients treated with Merocel (3.3%, 8/239). The rate of postoperative nasal cavity complications was 8.7% in patients with normal nasal cavity, 16.7% in patients who received treatment, and 20% in patients without treatment, with significant statistical increase if the nasal cavity was abnormal (p = 0.019). The incidence of complications influenced the primary success rate (p = 0.008); however, preoperative nasal cavity abnormalities were not correlated with primary success (p = 0.479).
CONCLUSIONS
In the case of endonasal DCR, preoperative nasal cavity abnormality and type of nasal packing material used did not affect the success rate but significantly affected postoperative nasal cavity complications. In conclusion, endonasal DCR with preoperative treatment of nasal cavity abnormality and Merocel packing is expected to reduce postoperative nasal cavity complications and increase patient satisfaction.

Keyword

Endonasal dacryocystorhinostomy (DCR); Nasal cavity abnormality; Nasal packing; Nasolacrimal duct obstruction

MeSH Terms

Dacryocystorhinostomy*
Granuloma
Humans
Incidence
Nasal Cavity*
Patient Satisfaction
Retrospective Studies

Reference

References

1. Whittet HB, Shun-Shin GA, Awdry P. Functional endoscopic transnasal dacryocystorhinostomy. Eye (Lond). 1993; 7:545–9.

2. Mandeville JTH, Woong JJ. Obstruction of the lacrimal drainage system. Curr Opin Ophthalmol. 2002; 13:303–9.

3. Kao SCS, Liao CL, Tseng JHS, et al. Dacryocystorhinostomy with intraoperative mitomycin C. Ophthalmology. 1997; 104:86–91.

4. Lee SH, Chung WS. Long term surgical efficacy of endonasal dacryocystorhinostomy. J Korean Ophthalmol Soc. 2000; 41:307–13.

5. Malhotra R, Wright M, Olver JM. A consideration of the time taken to do dacryocystorhinostomy (DCR) surgery. Eye. 2003; 17:691–6.

6. Woog JJ, Kennedy RH, Custer PL, et al. Endonasal dacryocystorhinostomy: a report by the American Academy of Ophthalmology. Ophthalmology. 2001; 108:2369–77.

7. Lee TS, Shin HH, Hwang SJ, Back SH. The results of revisional surgery for the failed endonasal DCR. J Korean Ophthalmol Soc. 2007; 48:186–92.

8. Yung MW, Hardman-Lea S. Analysis of the results of surgical endoscopic dacryocystorhinostomy: effect of the level of obstruction. Br J ophthalmol. 2002; 86:792–4.

9. Lee HC, Chung WS. Success rate of endonasal dacryocystorhinostomy. J Korean Ophthalmol Soc. 1996; 37:211–8.

10. Lee YJ, Moon SW, Cho HY, Jeong JH. Clinical outcome of dacryocystorhinostomy with septal deviation. J Korean Ophthalmol Soc. 2008; 49:713–20.

11. Boush GA, Lemke BN, Dorzbach RK. Results of endonasal laser assisted dacryocystorhinostomy. Ophthalmol. 1994; 101:955–9.

12. Gu BY, Kim WJ, Son JH. Learning curve for endonasal dacryocystorhinostomy. J Korean Ophthalmol Soc. 2011; 52:519–23.

13. Park JD, Kim YI, Shin SG. The factor related to surgical success rate of endonasal dacryocystorhinostomy. J Korean Ophthalmol Soc. 1998; 12:39.

14. Kim SJ, Kim SD. The surgical results of endonasal DCR with two silicone tubes in common canalicular obstruction. J Korean Ophthalmol Soc. 2007; 48:1170–6.

15. Sprekelson MB, Barberan MT. Endoscopic dacryocystorhinostomy: surgical technique and results. Laryngoscope. 1996; 106:187–9.

16. Ha TS, Na KS, Chi NC. Effectiveness of washing nasolacrimal duct as an additional therapy after dacryocystorhinostomy. J Korean Ophthalmol Soc. 2000; 41:2308–12.

17. Kong YT, Kim TI, Kong BW. A report of 131 cases of endoscopic laser lacrimal surgery. Ophthalmology. 1994; 101:1793–800.

18. Kim JH, shin JC. Clinical evaluation of endoscopic transnasal dacryocystorhinostomy. J Korean Ophthalmol Soc. 1997; 38:1706–11.

19. Iliff CE. A simplified dacryocystorhinostomy. Arch Ophthalmol. 1971; 85:586–91.

20. Lee DP, Yang SW, Choi WC. The relation between nasal cavity size and success rate in endonasal dacryocystorhinostomy. J Korean Ophthal Soc. 2000; 41:1118–23.

21. Metson R. Endoscopic surgery for lacrimal obstruction. Otolaryngol Head Neck Surg. 1991; 104:473–9.

22. Lee JJ, Woo KI, Kim YD. Middle turbinectomy during dacryocystorhinostomy. J Korean Ophthalmol Soc. 1997; 38:710–4.

23. Kim JM, Hong WP, Choi YJ, Kim SJ. The effect of nasal cavity abnormality related to surgical rate of endonasal dacryocystorhinostomy. J Korean Ophthalmol Soc. 2006; 47:1233–7.

24. Wang YP, Wang MC, Chen YC, et al. The effects of Vaseline gauze strip, Merocel, and Nasopore on the formation of synechiae and excessive granulation tissue in the middle meatus and the incidence of major postoperative bleeding after endoscopic sinus surgery. J Chin Med Assoc. 2011; 74:16–21.

25. Baek JS, Jang SY, Park TS, et al. Clinical results of Nasopore® nasal packing on endonasal dacryocystorhinostomy. J Korean Ophthalmol Soc. 2013; 54:557–61.

26. Sabiston DC. Textbook of surgery. 17th ed.Philadelphia: WB Saunders;2004. p. 183–204.

27. Jordan DR, Browstein S, Lee-Wing M, Ashenhurst M. Pyogenic granuloma following oculoplastic procedures: an imbalance in angiogenesis regulation. Can J Ophthalmol. 2001; 36:260–8.

28. Lee TS, Kim SW, Park BW. The relationship between rate of wound healing and success rate after endonasal laser drill assisted dacryocystorhinostomy. J Korean Ophthalmol Soc. 1999; 40:2969–74.

29. Shin HH, Lee TS, Baek SH. The comparision of surgical results of endonasal dacryocystorhinostomy in children and adults. J Korean Ophthalmol Soc. 2006; 47:877–82.

30. Ahn SM, Kim SS. Clinical application of polyether ester urethane in endonasal dacryocystorhinostomy. J Korean Ophthalmol Soc. 2012; 53:743–8.