Journal List > J Korean Ophthalmol Soc > v.56(5) > 1010263

Kim and Yang: The Clinical Efficacy of Cutanplast® Nasal Packing after Endonasal Dacryocystorhinostomy

초록

Purpose:

The purpose of this study was to investigate the clinical efficacy of Cutanplast® nasal packing after endonasal dacryocystorhinostomy.

Methods:

The present study included a total of 76 adult patients (98 eyes) with primary acquired nasolacrimal duct obstruction who underwent endonasal dacryocystorhinostomy. Fifty-four eyes were packed with Cutanplast® and 44 eyes were packed with Merocel®. Patient discomfort while the packing was in situ, degree of bleeding during the day after operation, functional and anatomical success rate, and postoperative complications such as synechiae, granulation, wound healing (osteal mucosal epithelium epithelization), and revision rate were compared between the packing materials.

Results:

The Cutanplast® was significantly more comfortable and effective at preventing hemorrhage after endonasal dacryocystorhinostomy during the day following the operation. There was no significant difference between the two groups in postoperative anatomical and functional surgical success rate at 1 week, 1 month and 3 months. In comparison with postoperative complications, the Cutanplast® group showed a lower incidence of delayed wound healing (delayed epithelialization of the osteal mucosal epithelium) than the Merocel® group, whereas there was no difference in granulation, synechiae, or revision rate.

Conclusions:

The Cutanplast® nasal pack resulted in significantly less discomfort and less bleeding compared to the Merocel® nasal pack. Moreover, the Cutanplast® showed a lower proportion of delayed wound healing after endonasal dacryocystorhinostomy and had the advantage of low cost compared to other hemostatic nasal packing materials. Therefore, Cutanplast® nasal packing after endonasal dacryocystorhinostomy can be considered a comfortable, cost-effective and clinically-effective method.

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Figure 1.
(A) The Cutanplast® is prepared by dividing it into four pieces. (B) Cutanplast® folded in half is inserted through the nose and (C) packed into the middle meatus. Several Cutanplast® are further inserted.
jkos-56-656f1.tif
Figure 2.
Endoscopic findings of the middle meatus after endonasal dacryocystorhinostomy with Cutanplast® packing. (A), (B) Liquefied hemostatic gelatin sponge (Cutanplast®) 1 week after application and can be gently removed by a suc-tion device. (C) Normal epithelization of the osteal mucosal epithelium with a silicone tube at 2 months. (D) Normally recovered epithelization of the osteal mucosal epithelium when the silicone tube removed at 3 months. C = liquefied Cutanplast®; NS = nasal septum; MT = middle turbinate; ST = silicone tube. * Osteal opening.
jkos-56-656f2.tif
Table 1.
Postoperative bleeding day after surgery
Grade
0 No bleeding
1 Slightly staining of dressing
2 Oozing, staining of half of dressing
3 Moderated bleeding, soaking almost all of dressing
4 Severe bleeding, soaking all of dressing and fresh blood show or bleeding after packing removal
Table 2.
Munk’s score
Grade
0 No epiphora
1 Occasional epiphora requiring dabbing less than twice a day
2 Epiphora requiring dabbing two to four times per day
3 Epiphora requiring dabbing 5-10 times per day
4 Epiphora requiring dabbing more than 10 times per day
5 Constant tearing
Table 3.
Patient demographics and characteristics at baseline
  Merocel® Cutanplast® p-value
Age (years) 56.4 ± 10.6 55.1 ± 8.5 0.561*
Sex (n, %)     0.617
  Male 5 (14.7) 8 (19.0)  
  Female 29 (85.3) 34 (81.0)  
Side (n, %)     0.888
  OD 23 (52.3) 29 (53.7)  
  OS 21 (47.7) 25 (46.3)  
Previous dacryocystitis history (n, %) 1 (2.27) 1 (1.9) 0.883
Mean time to tube removal (weeks) 11.8 ± 1.1 11.7 ± 1.2 0.629*

Values are presented as mean ± SD unless otherwise indicated.

OD = right eye; OS = left eye.

* Independent t-test,

Chi-square test.

Table 4.
Comparision of postoperative discomfort, bleeding, Munk’s score
  Type VAS/Grade
Mean ± SD p-value
  0 1 2 3 4
Discomfort during insertion Merocel® 0 3 21 9 1 2.05 ± 0.86 0.00*
Cutanplast® 14 20 16 4 0 1.13 ± 0.62  
Postoperative bleeding day after surgery Merocel® 0 5 20 14 5 1.98 ± 0.70 0.00*
Cutanplast® 1 22 25 4 1 0.65 ± 0.59  
  Type Munk’s score
Mean ± SD p-value
  0 1 2 3 4 5
Postoperative 1 week Merocel® 16 21 4 3 0 0 0.86 ± 0.85 0.423*
Cutanplast® 25 23 3 2 1 0 0.72 ± 0.88  
Postoperative 1 month Merocel® 15 20 4 2 3 0 1.05 ± 1.1 0.278*
Cutanplast® 25 19 6 3 1 0 0.81 ± 0.97  
Postoperative 3 months Merocel® 16 16 6 4 2 0 1.09 ± 1.1 0.401*
Cutanplast® 23 19 7 4 1 0 0.91 ± 1.0  

Values are presented as mean ± SD unless otherwise indicated.

VAS = visual analogue scale.

* Independent t-test.

Table 5.
Comparision of functional success rate and anatomical success rate
  Functional success rate
Anatomical success rate
  Merocel® Cutanplast® p-value Merocel® Cutanplast® p-value
Postoperative 1 week (%) 41/44 (93.18) 51/54 (94.44) 0.795* 42/44 (95.45) 51/54 (94.44) 0.821*
Postoperative 1 month (%) 39/44 (88.64) 50/54 (92.59) 0.500* 41/44 (93.18) 51/54 (94.44) 0.795*
Postoperative 3 months (%) 38/44 (86.36) 49/54 (90.74) 0.495* 41/44 (93.18) 50/54 (92.60) 0.910*

* Chi-square test.

Table 6.
Comparison of postoperative general complication
  Merocel® Cutanplast® p-value
Granuloma formation (n, %) 12 (27.3) 13 (24.7) 0.718*
Synechiae (n, %) 2 (4.5) 1 (1.9) 0.441*
Delayed wound healing (delayed epithelialization) (n, %) 5 (11.36) 1 (1.82) 0.051*
Revision (n, %) 3 (6.82) 1 (1.82) 0.217*

* Chi-square test.

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