Learning Curve for Endonasal Dacryocystorhinostomy

Byoung Young Gu; Won Jae Kim; Jun Hyuk Son

doi:10.3341/jkos.2011.52.5.519

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Gu, Kim, and Son: Learning Curve for Endonasal Dacryocystorhinostomy

Original Article

J Korean Ophthalmol Soc 2011;52(5):519-523.

Published online: 3 August 2011

DOI: https://doi.org/10.3341/jkos.2011.52.5.519

Learning Curve for Endonasal Dacryocystorhinostomy

Byoung Young Gu, MD, Won Jae Kim, MD, Jun Hyuk Son, MD

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea

Address reprint requests to Jun Hyuk Son, MD Department of Ophthalmology, Yeungnam University Medical Center #317-1 Daemyeong 5-dong, Nam-gu, Daegu 705-717, Korea Tel: 82-53-620-3444, Fax: 82-53-626-5936, E-mail: sjh@med.yu.ac.kr

Received 5 October 2010 Accepted 20 October 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 determine the learning curve of dacryocystorhinostomy (DCR) performed by a single oculoplastic surgeon after one year of fellowship training.

Methods

This retrospective review study comprised nasolacrimal duct obstruction patients that underwent endonasal DCR at our hospital between February 2006 and February 2008. The patients that completed at least six months of follow-up were included in the analysis. Exclusion criteria were patients less than 20 years of age and NLD obstructions due to malignancy or canalicular obstructions. Success was defined as duct patency on syringing at the final follow-up and no complaints of epiphora.

Results

Out of 161 eyes, the overall surgical success rate was 83.2% (134/161 eyes) and the mean postoperative follow-up period was 6.5 months (6-18 months). Success rates gradually increased as follows: 71.2% (37/52 eyes) for the first group, 88.7% (47/53 eyes) for the second group, and 89.3% (50/56 eyes) for the third group (second and third group compared to first group, p = 0.025, p = 0.017, respectively).

Conclusions

To ensure high DCR success rates, the novice surgeon should perform at least 50 surgeries.

Keywords: Endonasal dacryocystorhinostomy, Learning curve, Nasolacrimal duct obstruction

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Figure 1.

Success rates of endonasal dacryocystorhinostomy. ^* Chai-square test.

Figure 2.

Comparison of cause of surgical failures.

Table 1.

Characteristics of patients

	Group Ⅰ	Group Ⅱ	Group Ⅲ	p-value
Case (n)	52	53	56	0.199^*
Age (mean ± SD, yr)	55.3 ± 11.11	57.42 ± 10.69	59.93 ± 9.83	0.077^†
Sex (F:M)	9:43	10:43	12:44	0.860^‡

^* Pearson’s Chi-square test;

^† One-way ANOVA;

^‡ Chai-square test.

Table 2.

Time to postoperative removal of silicone tube

	Group Ⅰ	Group Ⅱ	Group Ⅲ	p-value
Case (n)	52	53	56	-
Removal of silicone tube (mean ± SD, mon)	4.23 ± 0.67	3.92 ± 1.19	4.34 ± 1.69	0.214^*

^* One-way ANOVA.

Table 3.

Surgical results of repeat operation

	Group Ⅰ	Group Ⅱ	Group Ⅲ
Case (n)	6	3	3
Success rate (%)	6/6 (100)	3/3 (100)	2/3 (66.7)

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