Clinical Effect of the Mixed Solution of Sodium Hyaluronate and Sodium Carboxymethylcellulose After Endonasal Dacryocystorhinostomy

Jung Won Park; Hong Yong Park; Kyung Chul Yoon

doi:10.3341/jkos.2010.51.6.795

Journal List > J Korean Ophthalmol Soc > v.51(6) > 1008829

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Park, Park, and Yoon: Clinical Effect of the Mixed Solution of Sodium Hyaluronate and Sodium Carboxymethylcellulose After Endonasal Dacryocystorhinostomy

Original Article

J Korean Ophthalmol Soc 2010;51(6):795-801.

Published online: 3 June 2010

DOI: https://doi.org/10.3341/jkos.2010.51.6.795

Clinical Effect of the Mixed Solution of Sodium Hyaluronate and Sodium Carboxymethylcellulose After Endonasal Dacryocystorhinostomy

Jung Won Park, MD, Hong Yong Park, MD, Kyung Chul Yoon, MD

Department of Ophthalmology, Chonnam National University Medical school and Hospital, Gwangju, Korea

Address reprint requests to Kyung Chul Yoon, MD Department of Ophthalmology, Chonnam National University Medical School & Hospital #8 Hak-dong, Dong-gu, Gwangju 501-757, Korea Tel: 82-62-220-6742, Fax: 82-62-227-1642, E-mail: kcyoon@chonnam.ac.kr

Received 7 December 2009 Accepted 23 March 2010

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 effects of a mixed solution of sodium hyaluronate and sodium carboxymethylcellulose (HACMC, Guardix-sol^®) for reducing postoperative adhesion after endonasal dacryocystorhinostomy.

Methods

Endonasal dacryocystorhinostomy was performed on 58 patients with obstructions of the nasolacrimal system. We divided the 58 patients into two groups. At the completion of endonasal dacryocystorhinostomy, HACMC was applied to the operative site in the experimental group (n=26) and normal saline was applied in the control group (n=32). For the evaluation of clinical effectsand postoperative adhesion, subjective symptom score evaluations, lacrimal irrigation tests, fluorescein disappearance tests, and endoscopic examinations were performed at 1 week, 1 month, 3 months, and 6 months postoperatively.

Results

The HACMC-treated patients showed better results than the control patients for subjective symptom scores, lacrimal irrigation tests, and fluorescein disappearance tests, but these differences were not statistically significant. Upon endoscopic examination, the HACMC group revealed lower incidence of adhesion at 1 week after surgery and lower severity of adhesion throughout the period of observation (p＜0.05).

Conclusions

The application of a mixed solution of HACMC may effectively reduce postoperative adhesion after endonasal dacryocystorhinostomy.

Keywords: Endonasal dacryocystorhinostomy, Guardix, HACMC, Hyaluronate, Sodium carboxymethylcellulose

References

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Figure 1.

Incidence and grading of adhesion in the control and HACMC groups on each postoperative day.

Figure 2.

Comparison of the incidence of adhesion formation in the control and HACMC groups on each postoperative day. In the HACMC group, the incidence of postoperative adhesion was lower than the control groups at 1 week after surgery statistically. ^* p<0.05 compared with the corresponding each control group.

Figure 3.

Comparison of the severity of adhesion in the control and HACMC groups on each postoperative day. In the HACMC group, the severity of postoperative adhesion was lower than the control groups throughout the period of observation statistically. ^* p<0.05 compared with the corresponding each control group.

Table 1.

Demographics of subjects undergoing endonasal DCR for NLDO

	HACMC^*-treated group (n=26)	Control (Normal saline) group (n=32)
Age (yr, mean± SD)	57.06±17.68	60.38±14.73
Male/Female	7/19	12/20
Mean time to stent removal (months)	3.48±0.68	3.67±0.57
Mean follow-up period (months)	6.58±1.67	6.86±1.24

^* HACMC=the mixed solution of hyaluronate and sodium carboxymethylcellulose (Guardix-sol^®).

Table 2.

The success rate according to subject symptom score, lacrimal irrigation and fluorescein disappearance test

		HACMC^*-treated group	Control group	p-value
Sx. Score
Postoperative	1 week	18/26 (69.2%)	18/32 (56.3%)	0.31
	1 month	20/26 (76.9%)	21/32 (65.6%)	0.35
	3 months	22/26 (84.6%)	24/32 (75.0%)	0.37
	6 months	23/26 (88.5%)	26/32 (81.3%)	0.45
Lacrimal irrigation test
Postoperative	1 week	24/26 (92.3%)	28/32 (87.5%)	0.55
	1 month	23/26 (88.5%)	26/32 (81.3%)	0.45
	3 months	22/26 (84.6%)	26/32 (81.3%)	0.74
	6 months	23/26 (88.5%)	26/32 (81.3%)	0.45
Fluorescein disappearance
Postoperative	1 week	16/26 (61.5%)	17/32 (53.1%)	0.52
	1 month	18/26 (69.2%)	22/32 (68.8%)	0.97
	3 months	21/26 (80.8%)	21/32 (65.6%)	0.20
	6 months	23/26 (88.5%)	27/32 (84.4%)	0.65
Total success rate
Postoperative	6 months	23/26 (88.5%)	26/32 (81.3%)	0.45

^* HACMC=the mixed solution of hyaluronate and sodium carboxymethylcellulose (Guardix-sol^®). The criteria of the success includes symptom score below score two. The criteria of the success include ‘good’ or ‘fair’ in lacrimal irrigation. The criteria of success include grade 0 or grade 1 in fluorescein disappearance.

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