Prognostic Factors for Successful Endonasal Dacryocystorhinostomy

Il Hwan Shin; Hyung Bin Lim; Jong Joo Lee; Sung Bok Lee

doi:10.3341/jkos.2015.56.11.1661

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Shin, Lim, Lee, and Lee: Prognostic Factors for Successful Endonasal Dacryocystorhinostomy

Original Article

J Korean Ophthalmol Soc 2015;56(11):1661-1666.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.11.1661

Prognostic Factors for Successful Endonasal Dacryocystorhinostomy

Il Hwan Shin, M.D, Hyung Bin Lim, M.D, Jong Joo Lee, M.D, Sung Bok Lee, M.D, PhD

Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea

Address reprint requests to Sung Bok Lee, MD, PhD Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea Tel: 82-42-280-7604, Fax: 82-42-255-3745 E-mail: sblee@cnu.ac.kr

‗ This study was presented as a narration at the 112th Annual Meeting of the Korean Ophthalmological Society 2014.

‗ This research was supported by Chungnam National University Hospital Research Fund, 2014.

Received 12 June 201523 June 2015 Accepted 4 September 2015

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 factors useful for predicting the surgical outcome of endonasal dacryocystorhinostomy.

Methods

This retrospective observational study included 117 eyes of 94 patients with nasolacrimal duct obstruction who under-went endonasal dacryocystorhinostomy and were followed up for more than 6 months. Factors associated with successful sur-gery were analyzed based on the preoperative and intraoperative factors and postoperative clinical features. Preoperative fac-tors such as age, gender, laterality, presence or absence of hypertension, and diabetes were analyzed. Intraoperative factors such as use of triamcinolone, removal of uncinate process or middle turbinate during surgery, and location of the sac were analyzed. The postoperative clinical features including high tear meniscus, no intranasal silicone tube movement, and no air re-flux feeling were each given a score of 1. Based on aggregate score, the patients were divided into 2 groups, the high score and low score groups and analyzed accordingly.

Results

The success rate was 91.5%. Patients with diabetes showed a significantly low success rate (73.3%, p = 0.007). In pa-tients with high tear meniscus at 3, 6, and 9 weeks after surgery, the success rate was significantly low (76.9%, 81.8% and 75.0%; p = 0.003, p = 0.029 and p = 0.002, respectively). The low score group at 3 and 6 weeks after surgery showed a sig-nificantly high success rate (100% and 95.9%; p < 0.001 and p = 0.023, respectively).

Conclusions

Besides preoperative and intraoperative factors, the early postoperative clinical features are important for predict-ing the success of the surgery. If tear meniscus is high and there is no intranasal silicone tube movement and air reflux from the punctum in the early stages after surgery, more active management from the initial treatment is needed.

Keywords: Endonasal dacryocystorhinostomy, Nasolacrimal duct obstruction, Prognostic factors, Success rate

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Figure 1.

Relationship between clinical score and final success according to the time. Success rates in high score group are lower at 3 weeks, 6 weeks, and 9 weeks after surgery than those in low score group. Especially the success rates on 3 and 6 weeks show a statistically significant difference. ^* Chi-square test.

Table 1.

Patient demographics

Characteristics	Values
Age (years)	56.8 ± 12.0
Gender (patients, %)	94
Male	13 (13.8)
Female	81 (86.2)
Laterality (eyes, %)	117
Right	50 (42.7)
Left	67 (57.3)
Hypertension (patients, %)	25 (26.6)
Diabetes mellitus (patients, %)	9 (9.6)

Values are presented as mean ± SD unless otherwise indicated.

Table 2.

Relationship between preoperative factors and final success

Preoperative factors	Success rate (eyes, %)		p-value^*
	(+)	(-)
Female sex	93/101 (92.1)	14/16 (87.5)	0.625
Right laterality	45/50 (90.0)	62/67 (92.5)	0.742
Hypertension	30/32 (93.8)	77/85 (90.6)	0.726
Diabetes mellitus	11/15 (73.3)	96/102 (94.1)	0.007
Young age^†	58/62 (93.5)	49/55 (89.0)	0.389

^* Chi-square test

^† Divided by the average value (56.8 years) of the patients age.

Table 3.

Relationship between intraoperative factors and final success

Intraoperative factors	Success rate (eyes, %)		p-value^*
	(+)	(-)
Triamcinolone	58/62 (93.5)	49/55 (89.1)	0.513
Middle turbinectomy	29/32 (90.6)	78/85 (91.8)	0.844
Uncinectomy	39/40 (97.5)	68/77 (88.3)	0.161
High lacrimal sac	40/43 (93.0)	67/74 (90.5)	0.744

^* Chi-square test.

Table 4.

Relationship between postoperative clinical features and final success

Postoperative clinical features	Postoperative	Success rate (eyes, %)		p-value^*
		Score 0	Score 1
High tear meniscus	3 weeks	86/90 (95.6)	20/26 (76.9)	0.003
	6 weeks	75/79 (94.9)	27/33 (81.8)	0.029
	9 weeks	64/68 (94.1)	15/20 (75.0)	0.002
Silicone tube moving	3 weeks	61/65 (93.8)	46/52 (88.5)	0.336
	6 weeks	78/84 (92.9)	29/33 (87.9)	0.465
	9 weeks	102/111 (91.9)	5/6 (83.3)	0.422
Air reflux	3 weeks	21/22 (95.5)	86/95 (90.5)	0.685
	6 weeks	82/89 (92.1)	25/28 (89.3)	0.701
	9 weeks	56/60 (93.3)	51/57 (89.5)	0.522

High tear meniscus, no intranasal silicone tube movement and no air reflux feeling, which are expected to be worse prognosis, were given score 1 respectively, the opposition given score 0.

^* Chi-square test.

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