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.
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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) |
Table 2.
Preoperative diagnosis of patients
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) |
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) |
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) |
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) |
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 |