Effect of Silver Nitrate Application on the Success of Endoscopic Dacryocystorhinostomy

Abstract

Objectives To compare the clinical outcomes of patients undergoing additional procedures in endoscopic endonasal dacryocystorhinostomy (End-DCR) surgery and discuss the factors affecting the success of End-DCR surgery in light of relevant literature. Methods The study included 155 patients who underwent End-DCR surgery in our clinic due to epiphora. This was a prospective randomized, single-blind, controlled trial. Group I (control) included 54 patients who did not undergo silicone stent insertion or silver nitrate application, group II included 51 patients who underwent silicone stent insertion only, and group III included 50 patients who underwent silver nitrate application only. Statistical analysis was performed on follow-up data regarding anatomic and functional success rates. Results Revision surgery was performed in 16 patients who developed persistent epiphora in the postoperative period, including 6 in group I, 7 in group II, and 3 in group III (P = .4). The most common reason for revision surgery was stenosis of the neo-ostium (n = 8), followed by granulation tissue formation (n = 5) and synechia formation (n = 3). Granuloma formation was the most common postoperative complication, and a significant difference was found among the groups with regard to granuloma formation (P = .04). At postoperative month 12, the functional success rate was estimated to be 88%, 86%, and 94%, and the anatomic success rate was estimated to be 94%, 92%, and 96% in groups I, II, and III, respectively, with no significant difference, found among the 3 groups with regard to both rates (P = .79 and P = .76, respectively). Conclusion The results indicated that stenting and silver nitrate application did not affect surgical success. Our preliminary results on silver nitrate cauterization showed that it is an effective, inexpensive, and practical method to reduce granulation formation in the postoperative period.