Effectiveness of synthetic polyurethane foam as a nasal packing material in endoscopic endonasal dacryocystorhinostomy

Purpose: Tocompare the effects of 2 nasal packing materials, synthetic polyurethane foam (absorbable) and expandable polyvinyl acetate (nonabsorbable), on the surgical success rate and postoperative complications after endoscopic endonasal dacryocystorhinostomy (EDCR). Methods: A retrospective medical review of 459 patients (580 eyes) who underwent EDCR for primary acquired nasolacrimal duct obstruction at Korea University Guro Hospitals from January 2009 to February 2014. Surgical success rate (anatomical, functional), postoperative complications (granuloma, synechia, bleeding, and infection) were compared between the 2 groups, absorbable (318 eyes) and nonabsorbable (262 eyes). Results: The absorbable group showed better results in surgical success rate regarding anatomical (90.5% versus 76.3%, P=0.00) and functional (89.3% versus 75.9%, P=0.00). Granulomas developed less frequently in the absorbable group (24.5% versus 38.9%, P=0.00).Also, bleeding and crust were less frequent in the absorbable group (P=0.00). Infections were less frequent in the nonabsorbable group (1.52%) comparedwith the absorbable group (7.86%,P=0.00). The rate of revision surgery was lower in the absorbable group (7.86% versus 20.9%, P=0.00). As for the influence of secondary outcomes to the surgical success by multiple logistic regression, granulomas had the largest effect on surgical success either anatomical or functional (odds ratio=82.393 to anatomical and 44.058 to functional). Synechia had the second largest effect on surgical success (odds ratio=11.897 to anatomical and 9.605 to functional). Conclusions: The authors suggest that using a synthetic polyurethane foam as a nasal packing material is not only a surgical option, but also a crucial and essential procedure in EDCR.