The Clinical Effects of Triamcinolone-soaked Nasal Packing on Endonasal Dacryocystorhinostomy

Seok Hyeon Song; Ka Hyun Lee

doi:10.3341/jkos.2018.59.4.307

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Song and Lee: The Clinical Effects of Triamcinolone-soaked Nasal Packing on Endonasal Dacryocystorhinostomy

Original Article

J Korean Ophthalmol Soc 2018;59(4):307-313.

Published online: 7 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.4.307

The Clinical Effects of Triamcinolone-soaked Nasal Packing on Endonasal Dacryocystorhinostomy

Seok Hyeon Song, MD^1,², Ka Hyun Lee, MD^1,^2,

^¹Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea

^²Myunggok Medical Research Institute, Konyang University, Daejeon, Korea

Address reprint requests to Ka Hyun Lee, MD Department of Ophthalmology, Konyang University Hospital, #158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Korea Tel: 82-42-600-9258, Fax: 82-42-600-9251, E-mail: chullan@kyuh.ac.kr

Received 23 November 2017 Revised 28 December 2017 Accepted 1 April 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the clinical effects of triamcinolone-soaked nasal packing on endonasal dacryocystorhinostomy (DCR).

Methods

The study included 91 patients (156 eyes) with primary acquired nasolacrimal duct obstruction who underwent endonasal DCR from March 2015 to February 2017. A total of 50 eyes were packed with triamcinolone-soaked Nasopore® and 106 eyes were packed with Nasopore® without triamcinolone (control group). The anatomical and functional success percentage, revision percentage, and postoperative complications such as granulation, synechiae, and membrane formation were compared between the groups at 1 week, 1 month, 2 months, and 4 months postoperatively.

Results

At postoperative 2 months, there was a statistically significant difference in the anatomical success percentage in the triamcinolone-soaked group (100%) compared to the control group (86.8%; p = 0.007). There were no statistically significant differences between the two groups in anatomical success percentage at postoperative 4 months (p > 0.05). However, there was a statistically significant difference in the functional success percentage in the triamcinolone-soaked group (92.0%) compared to the control group (78.3%; p = 0.035). When comparing postoperative complications, the triamcinolone-soaked group (4.0%) had a lower incidence of granulation than the control group (16.0%) (p = 0.032), but there were no differences in synechiae and membrane formation (p > 0.05). There was a statistically significant difference in the revision percentage in the triamcinolone-soaked group (4.0%) compared to the control group (16.0%) (p = 0.032).

Conclusions

Triamcinolone-soaked nasal packing for endonasal DCR is an effective method for increasing the success percentage and lowering the incidence of granuloma and revision percentages.

Keywords: Endonasal dacryocystorhinostomy, Nasopore, Triamcinolone

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Figure 1.

Endoscopic view of one patient. Endoscopic appearance of the middle meatus (A) before endonasal dacryocystorhinostomy, (B) after endonasal dacryocystorhinostomy with triamcinolone-soaked Nasopore® packing.

Figure 2.

Comparison of the anatomical success percentage between the two groups over time. At postoperative 2 months, there was a statistically significant difference in the anatomical success percentage in the triamcinolone-soaked group compared to the control group (p = 0.007). There were no statistically significant differences between the two groups in anatomical success percentage at postoperative 4 months (p > 0.05).

Figure 3.

Comparison of the functional success percentage between the two groups over time. At postoperative 4 months, there was a statistically significant difference in the functional success percentage between the two groups (p = 0.035).

Table 1.

Patient demographics and characteristics at baseline

	No triamcinolone (n = 106)	Triamcinolone (n = 50)	p-value
Age (years)	59.74 ± 10.61	59.96 ± 13.47	0.165*
Sex (n, %)
Male	21 (19.8)	6 (12.0)	0.229^†
Female	85 (80.2)	44 (88.0)
Side (n, %)
Right	47 (44.3)	28 (56.0)	0.174^†
Left	59 (55.7)	22 (44.0)
DM (n, %)	9 (84.9)	1 (2.0)	0.122^†
HTN (n, %)	28 (26.4)	12 (24.0)	0.747^†
Antiplatelet (n, %)	13 (12.3)	3 (6.0)	0.229^†
Previous dacryocystitis history (n, %)	3 (2.8)	0 (0)	0.230^†
Mean time to tube removal (weeks)	8.76 ± 2.24	8.80 ± 1.21	0.916*
Total follow up period (months)	5.98 ± 1.79	6.08 ± 1.05	0.718*

Values are presented as mean ± SD or number (%) unless otherwise indicated.

SD = standard deviation; DM = diabetes mellitus; HTN = hypertension.

^* independent t-test;

^† Chi-square test.

Table 2.

Comparison of the anatomical success percentage

	No triamcinolone (n = 106)	Triamcinolone (n = 50)	p-value*
Postoperative 1 week (n, %)	102 (96.2)	50 (100)	0.164
Postoperative 1 month (n, %)	102 (96.2)	50 (100)	0.164
Postoperative 2 month (n, %)	92 (86.8)	50 (100)	0.007
Postoperative 4 month (n, %)	93 (87.7)	48 (96.0)	0.102

Values are presented as n (%) unless otherwise indicated.

^* Chi-square test.

Table 3.

Comparison of the functional success percentage

	No triamcinolone (n = 106)	Triamcinolone (n = 50)	p-value*
Postoperative 1 week (n, %)	81 (76.4)	49 (98.0)	0.001
Postoperative 1 month (n, %)	84 (79.2)	44 (88.0)	0.184
Postoperative 2 month (n, %)	83 (78.3)	43 (86.0)	0.255
Postoperative 4 month (n, %)	83 (78.3)	46 (92.0)	0.035

Values are presented as n (%) unless otherwise indicated.

^* Chi-square test.

Table 4.

Comparison of postoperative complications

	No triamcinolone (n = 106)	Triamcinolone (n = 50)	p-value*
Revision (n, %)	17 (16.0)	2 (4.0)	0.032
Granuloma formation (n, %)	17 (16.0)	2 (4.0)	0.032
Synechiae (n, %)	2 (1.8)	1 (2.0)	0.962
Membrane formation (n, %)	5 (4.7)	0 (0)	0.119

Values are presented as n (%) unless otherwise indicated.

^* Chi-square test.

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