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Oh, Paik, and Yang: Results of the Mixed Solution of Hyaluronate and Sodium Carboxymethylcellulose in Endonasal Dacryocystorhinostomy
Original Article

J Korean Ophthalmol Soc 2010;51(2):159-163.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.2.159

Results of the Mixed Solution of Hyaluronate and Sodium Carboxymethylcellulose in Endonasal Dacryocystorhinostomy

Tae-Hoon Oh, MD, Ji Sun Paik, MD, Suk-Woo Yang, MD

Department of Ophthalmology, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Suk-Woo Yang, MD Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University #505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea Tel: 82-2-2258-2846, Fax: 82-2-599-7405, E-mail: yswoph@catholic.ac.kr

Received 19 October 2009       Accepted 29 December 2009

Copyright © 2010 Korean Ophthalmological Society

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 long-term results of the application of a mixed solution of hyaluronate and sodium carboxymethlycellulose (HACMC, Guardix-sol) intraoperatively in endonasal dacryocystorhinostomy (Endo-DCR).

Methods

In this retrospective randomized controlled study, Endo-DCR and silicone tube intubation were performed on 83 eyes of 83 patients who were diagnosed with nasolacrimal duct obstruction. In group A (40 patients, 40 eyes), HACMC was applied to the osteotomy site in the nasal cavity after standard Endo DCR procedure. In group B (43 patients, 43 eyes), a standard Endo-DCR procedure was performed without HACMC. The results for the two groups were evaluated by asking patients about the tearing condition and examining the patency of irrigation, complications, and related treatment.

Results

There were no statistically significant differences in age, sex, silicone tube insertion duration, or mean follow-up time between the two groups. The primary success rates of the group A and the group B were 87.5% (35/40) and 81.4% (35/43), respectively. The final success rates after the revisonal surgery were 92.5% (37/40) and 86.0% (37/43), respectively, and there were no statistically significant differences between the two groups (P=0.348, Fisher's exact test).

Conclusions

Applying HACMC to the nasal cavity will be useful in treating patients with poor prognosis, although the higher average primary success rate of patients receiving HACMC, as compared to those who did not, was not statistically significant.

Keywords: Endonasal dacryocystorhinostomy, Hyaluronate and sodium carboxymethylcellulose (HACMC), Synechia

References

1. Toti A. Nuovo metodo conservatore di cura radical delle suppor-azioni chronoche del sacco lacrimale. Clin Moderna. 1904; 10:385–9.
2. Zollin CL, Shannonn GM. Dacryocystorhinostomy: a review of 119 cases. Ophthalmic Surg. 1982; 13:905–10.
3. Burns JA, Cahill KV. Modified Kinosian dacryocystorhinostomy: a review of 119 cases. Ophthalmic Surg. 1985; 16:710–6.
4. Roozitalab MH, Amirahmadi M, Namazi MR. Results of the application of intraoperative mitomycin C in dacryocystorhinostomy. Eur J Ophthalmol. 2004; 14:461–3.
crossref
5. Kong YT, Kim TI, Kong BW. A report of 131 cases of endoscopic laser lacrimal surgery. Ophthalmology. 1994; 101:1793–800.
crossref
6. Leone CR. Gelfoam-thrombin dacryocystorhonostomy. Am J Ophthalmol. 1982; 94:412–3.
7. Rosen N, Sharir M, Moverman DC. Dacryocystorhinostomy with silicone tubes evaluation of 253 cases. Ophthalmic Surg. 1989; 20:115–9.
crossref
8. Park DJ, Kwak MS. The effect of mitomycin C on the success rate of endoscopic dacryocystorhinostomy. J Korean Ophthalmol Soc. 2000; 41:1674–9.
9. Kim KS, Yoon HC, Lee JH, et al. Antiadhesive effect of guardix-sl after endoscopic sinus surgery. Korean J Otolaryngol. 2005; 48:1478–83.
10. Kwon SW, Seo YW, Cho YA. Antiadhesive effect of the mixed solution of hyaluronate and sodium carboxymethylcellulose after strabismus surgery. J Korean Ophthalmol Soc. 2009; 50:145–50.
crossref
11. Frenkiel S, Desrosiers MY, Nachtigal D. Use of hylan B gel as a wound dressing after endoscopic sinus surgery. J Otolaryngol. 2002; 31:41–4.
crossref
12. Lee JM, Lee YJ, Kim JH. The effect of Mitomycin C aberrations in Endonasal Dacryocystorhinostomy. J Korean Ophthalmol Soc. 2004; 45:1609–14.
13. Caldwell GW. Two new operations for obstruction of the nasal duct with preservation of the canaliculi and an incidental description of a new lacrimal probe. Am J Ophthalmol. 1893; 10:189.
14. Boush GA, Lemke BN, Dorzbach RK. Results of endonasal laser-assisted dacrycystorhinos tomy. Ophthalmology. 1994; 101:955–9.
15. Lee HC, Chung WS. Success rate of endonasal aberrations. J Korean Ophthalmol Soc. 1996; 37:211–8.
16. Kao SC, Liao CL, Tseng JH, et al. Dacryocystorhinostomy with intraoperative mitomycin C. Ophthalmology. 1997; 104:86–91.
crossref
17. Yeatts RP, Neves RB. Use of mitomycin-C in repeat aberrations. Ophththalmic Plast Reconstruct Surg. 1999; 15:19–22.
18. Zilelioglu G, Ugurbas SH, Anadolu Y, et al. Adjunctive use of mitomycin C on endoscopic lacrimal surgery. Br J Ophthalmol. 1998; 82:63–6.
19. Kimmelman CP, Edelstein DR, Cheng HJ. Sepragel sinus(hylan B) as a postsurgical dressing for endoscopic sinus surgery. Otolaryngol Head Neck Surg. 2001; 125:603–8.
20. Bar A, Van Ommen B, Timonen M. Metabolic disposition in rats of regular and enzymatically depolymerized sodium aberrations. Food Chem Toxicol. 1995; 33:901–7.
21. Lindberg JV, Anderson RL, Bumsted RM, Barretas R. Study of intranasal ostium external dacryocystorhinostomy. Arch aberrations. 1982; 100:1758–62.

Figure 1.
0.25% sodium hyaluronate + 0.49% carboxymethylcellulose (Gardix-sol, Hanmi MediCare, Korea).
jkos-51-159f1.tif
Table 1.
Demographic data of patients
Group A Group B
Age (Year) 51.5±11.7 55.8±14.1
Number of patients 40 43
Female 36 (90.0%) 40 (93.0%)
Male 4 (10.0%) 3 (6.9%)
Silicone tube removal (months) 3.96±2.32 4.25±1.72
Follow-up time after surgery (months) 7.48±4.29 7.56±4.52

Group A: Intraoperative Hyaluronate and sodium carboxymethylcellulose (HACMC, Guardix-sol) injection; Group B: Control group.

Table 2.
Preoperative diagnosis in two groups
Number of cases (%)
Group A (n=40) Group B (n=43)
Nasolacrimal duct obstruction 22(55.5%) 25(58.1%)
Chronic dacryocystitis 16(40.0%) 17(39.5%)
Previous failed DCR* 2(5.0%) 1(2.3%)

* DCR: Dacryocystorhinostomy.

Table 3.
Total success rate of DCR
Number of case (%)
Group A (n=40) Group B (n=43)
Primary Success* Rate 87.5%(35/40) 81.4%(35/43)
Final Success Rate 92.5%(37/40) 86.0%(37/43)

* Success: There was no subjective symptom or improvement in tearing, and the lacrimal drainage system was proved to be patent by irrigation.

Table 4.
Causes of postoperative failure and number of eyes
Group A Group B
Membranous obstruction of interanl ostium 3(1) 5(4)
Common canalicular obstruction 2 1
Granuloma 0 1

(): Final number of eyes after reoperation.

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