Analysis of the Results Endonasal Dacryocystorhinostomy Related to Nasal Cavity State

Seung Kook Baek; Myung Sook Ha

doi:10.3341/jkos.2014.55.5.633

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Baek and Ha: Analysis of the Results Endonasal Dacryocystorhinostomy Related to Nasal Cavity State

Original Article

J Korean Ophthalmol Soc 201;55(5):633-639.

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.5.633

Analysis of the Results Endonasal Dacryocystorhinostomy Related to Nasal Cavity State

Seung Kook Baek, MD, Myung Sook Ha, MD

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

Address reprint requests to Myung Sook Ha, MD, Department of Ophthalmology, Konyang University Hospital, #158 Gwanjeodong-ro, Seo-gu, Daejeon 302-718, Korea, Tel: 82-42-600-9258, Fax: 82-42-600-9251, E-mail: hmseye@hanmail.net

Received 16 August 2013 Revised 4 November 2013 Accepted 15 March 2014

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

This study evaluated the relationship of nasal cavity state and surgical results after endonasal dacryocystorhinostomy (DCR).

Methods

We retrospectively analyzed 306 eyes of 204 patients between January 2007 and December 2011. The correlation between the existence of preoperative nasal cavity abnormality, postoperative nasal cavity complications after proper management of nasal cavity abnormality, and postoperative nasal cavity complications according to nasal packing material were investigated. We analyzed the success rates and the correlation between each set of factors.

Results

The success rate of primary operations performed six months after tube removal was 87.3% (267/306). The success rate after secondary revision, granuloma removal and punctoplasty was 90.5% (277/306). Postoperative nasal cavity complications were inspected in 40 eyes. Of the 306 eyes, patients treated with Nasopore showed significantly more postoperative nasal cavity complications (47.8%, 32/67) than in patients treated with Merocel (3.3%, 8/239). The rate of postoperative nasal cavity complications was 8.7% in patients with normal nasal cavity, 16.7% in patients who received treatment, and 20% in patients without treatment, with significant statistical increase if the nasal cavity was abnormal (p = 0.019). The incidence of complications influenced the primary success rate (p = 0.008); however, preoperative nasal cavity abnormalities were not correlated with primary success (p = 0.479).

Conclusions

In the case of endonasal DCR, preoperative nasal cavity abnormality and type of nasal packing material used did not affect the success rate but significantly affected postoperative nasal cavity complications. In conclusion, endonasal DCR with preoperative treatment of nasal cavity abnormality and Merocel packing is expected to reduce postoperative nasal cavity complications and increase patient satisfaction.

Keywords: Endonasal dacryocystorhinostomy (DCR), Nasal cavity abnormality, Nasal packing, Nasolacrimal duct obstruction

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Table 1.

Demographics of 204 patients who undergone 306 endonasal DCR surgeries

Sex (no. of patients)
Male	32
Female	172
Total	204
Mean ages (years)	54.93 ± 13.20
Lateralization (no. of eyes)
OD	42
OS	60
OU	204
Total	306
Extubation time (months)	3.59 ± 1.29
Follow-up time	9.52 ± 3.24
after extubation (months)
Nasal cavity dressing (number)	6.57 ± 2.54
Primary success rate^*	87.3% (267/306)
Secondary success rate^†	90.5% (277/306)

Values are presented as mean ± SD.

^* 6 months later after extubation;

^† After DCR revision, Granuloma removal, Snip operation.

Table 2.

Preoperative diagnosis of patients

Diagnosis	No. of eyes (%)
Chronic dacryocystitis	214 (69.93)
Partial canalicular obstruction	67 (21.90)
Failure of probing and tube intubation	20 (6.53)
History of acute dacryocystitis	4 (1.31)
Dacryocystocele	1 (0.33)
Total	306 (100)

Table 3.

Causes of failure after endonasal DCR

Causes of failure	No. of eyes (%)
Functional tearing^*	24 (61.54)
Canalicular obstruction	6 (15.38)
Granuloma formation	3 (7.69)
Synechiae formation	3 (7.69)
Membranous obstruction	2 (5.13)
Punctal stenosis	1 (2.57)
Total	39 (100)

^* Epiphora after endonasal DCR without anatomical or eyeball surface abnormalities.

Table 4.

Factors of postoperative nasal cavity complications which related to result of endonasal DCR

Postoperative complications	No. of eyes (%)
Granuloma formation	27 (67.5)
Membranous obstruction	7 (17.5)
Synechiae formation	6 (15.0)
Total	40 (100)

Table 5.

Result of postoperative nasal cavity complications related to preoperative nasal cavity abnormality

Preop. nasal cavity		No complications(%)	Complications(%)
Normal		168 (91.3)	16 (8.7)
Abnormal	Correction (-)	88 (80)	22 (20)
	Correction (+)	10 (83.3)	2 (16.7)
Total		266 (86.9)	40 (13.1)

p = 0.019, Fisher's exact test.

Table 6.

Results of endonasal DCR related to postoperative nasal cavity complications

Postop. nasal cavity	Success (%)	Failure (%)
No complications	238 (89.5)	28 (10.5)
Complications	29 (72.5)	11 (27.5)
Total	267 (87.3)	39 (12.7)

p = 0.08, Chi-square test.

Table 7.

Result of endonasal DCR related to preoperative nasal cavity abnormality

Preop. nasal cavity		Success (%)	Failure (%)
Normal		164 (89.1)	20 (10.9)
Abnormal	Correction (-)	93 (84.5)	17 (15.5)
	Correction (+)	10 (83.3)	2 (16.7)
Total		267 (87.3)	39 (12.7)

p = 0.479, Fisher's exact test.

Table 8.

Comparison of postoperative nasal cavity complications and success rate between Merocel and Nasopore nasal packing material after endonasal DCR

	Complications (%)	Success (%)
Merocel	8/239 (3.3)	212/239 (88.7)
Nasopore	32/67 (47.8)	55/67 (82.1)
Total	40/306 (13.1)	267/306 (87.3)
p-value^*	0.000	0.152

^* By Chi-square test.

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