Fibrovascularization of Intraorbital Hydroxyapatite-Coated Alumina Sphere in Rabbits

We investigated the fibrovascular ingrowth and fibrovascular tissue maturation of hydroxyapatite-coated, porous alumina sphere (Alumina sphere) in comparison with the hydroxyapatite sphere (HAp sphere) in rabbits. Alumina spheres and HAp spheres were implanted in the left orbits of 42 New Zealand white rabbits after enucleation. Fibrovascular ingrowth and maturation were graded from 1 to 5 at postoperative 1, 2, 3, 4, 8, 12 and 24 weeks. We defined 4 phases: postoperative 1-2 weeks as phase I, 3-4 weeks as phase II, 8-12 weeks as phase III, and 24 weeks as phase IV. The grade was analyzed at each phases. There was no significant difference in fibrovascular ingrowth and maturation between the two groups at all 4 phases, except phase II at which the Alumina sphere showed significantly lower maturation grade (p< 0.05). We concluded that the Alumina sphere is an ideal orbital implant material and an ideal substitute for the HAp sphere in clinical practice.

Correction of Superior Sulcus Deformity and Enophthalmos with Porous High-density Polyethylene Sheet in Anophthalmic Patients

PURPOSE: Superior sulcus deformity is the main cosmetic problem in anophthalmic patients. Many methods of correcting enophthalmos have been reported, especially in patients with orbital wall fracture. The purpose of this study is to review the long term results of effectiveness in superior sulcus deformity correction by subperiosteal Medpor (R) sheet implantation in anophthalmic patients. METHODS: Subperiosteal Medpor (R) sheets were used in 11 eyes of 11 anophthalmic patients. To estimate the effectiveness, photographs were taken and exophthalmometric value with their own prosthesis using Hertel exophthalmometer was measured in all patients before and after surgery. RESULTS: The overall cosmetic results in superior sulcus deformity were 'excellent' in 3 (27.3%), 'good' in 6 (54.5%), 'fair' in 2 (18.2%). The overall results in enophthalmos were 'excellent' in 3 (27.2%), 'markedly improved' in 4 (36.4%), 'slightly improved' in 4 (36.4%). Most patients had a marked increase in orbital volume, except two patients. They received irradiation treatment in early childhood so showed unsatisfactory results in both superior sulcus deformity and enophthalmos. CONCLUSIONS: Subperiosteal Medpor (R) sheet implantation is considered to be a reliable and safe procedure without serious complication and with an excellent cosmetic results.

Three Cases of Orbitofrontal Cholesterol Granuloma

PURPOSE: To report three cases of orbitofrontal cholesterol granuloma. METHODS: The study subjects were three patients with chief complaints of proptosis and upgaze limitation of ocular movement. Exophthalmometric values were 4~8 mm by Hertel exophthalmometer. Orbital CT and MRI scans were taken in all patients, and regarded as orbitofrontal cholesterol granuloma. In all cases, excisional biopsy was done through the lateral approach. RESULTS: Orbital CT scan showed an isodense to hypodense, well-defined, homogeneous mass and osteolytic lesion in the adjacent superolateral bony orbit. Orbital MRI scan showed a mass with high signal intensity in both T1- and T2-weighted images. Histopathologically, the specimen showed numerous slits like cholesterol clefts surrounded by multinucleated, foreign body type, giant cells with hemosiderin pigments. CONCLUSIONS: Orbitofrontal cholesterol granuloma, although rare, has typical clinical and radiologic features. Surgical excision has a high success rate without recurrence.

Evaluation and Treatment of True Ptosis in Double Elevator Palsy

PURPOSE: To estimate the predictable factors of postoperative true ptosis remaining after squint surgery in patients with double elevator palsy (DEP), and to analyze the factors that must be considered before the correction of true ptosis. METHODS: We retrospectively reviewed the medical records of 6 patients who had undergone strabismus surgery for DEP at the Department of Ophthalmology, Yeungnam University College of Medicine, between 1989 and 2003. The MRD (margin reflex distance) of paretic and nonparetic eye with each eye fixation, palpebral aperture, levator function, and Bell's phenomenon were analyzed before and after squint surgery. RESULTS: True ptosis was noted in 3 patients, one of whom underwent external levator resection. Postoperative Bell's phenomenon improved in 2 patients who had poor Bell's phenomenon preoperatively. Scleral show remained in 2 patients who underwent inferior rectus recession, and was taken into account before the correction of ptosis. CONCLUSIONS: Upper lid drooping in DEP patients is expected to be improved after squint surgery if preoperative MRD of paretic eye with paretic eye fixation has the same measured amount as that of non-paretic eye. MRD, Bell's phenomenon and the amount of scleral show after the squint surgery should be carefully examined and assessed before the correction of residual ptosis.

Surgical Effect of Canaliculodacryocystorhinostomy in Patients with Failed Conjunctivodacryocystorhinostomy

PURPOSE: To analyze outcomes of the canaliculodacryocystorhinostomy and the combined procedure of canaliculodacryocystorhinostomy and Jones tube reinsertion, in patients who had complications of conjunctivodacryocystorhinostomy, which required other surgical procedures. METHODS: We retrospectively analyzed the outcomes of 18 eyes (16 patients) who visited the Department of Ophthalmology, Yeungnam University Hospital for functional failures and complications of conjunctivodacryocystorhinostomy, and who underwent either the canaliculodacryocystorhinostomy or the combined procedure between February 1994 and October 2003. These patients had submerged, prolapsed, lost, or obstructed Jones tubes, with a length of patent canaliculi from the puncta of more than 7mm, identified with probing, irrigation and dacryocystography. RESULTS: Complete or significant improvement of epiphora was achieved in 83.3% (15 of 18 eyes) after a follow-up period ranging 6 to 70 months (average 28.5 months). CONCLUSIONS: Canaliculodacryocystorhinostomy and the combined procedure can be expected to achieve functional success in patients who suffer from complications of the Jones tube. We recommend these procedures in cases of common canalicular obstruction and upper and lower canalicular obstruction with a length of patency greater than 7mm.

Preoperative Axial Length Measured by Ultrasonography in Phthisis Bulbi

PURPOSE: The preoperative axial length measured by ultrasonography in the phthisis bulbi and the postoperative surgical outcome was evaluated in order to determine the surgical procedure of an evisceration or enucleation. METHODS: The preoperative axial length was measured by ultrasonography in 30 eyes of 30 patients with phthisis bulbi from January 2000 to October 2002. Enucleation was performed on 20 eyes with a relatively short preoperative axial length. The axial length of the enucleated globe was measured and compared with the preoperative axial length. Evisceration was performed in 10 eyes with a relatively long preoperative axial length. The size of the implant, the thickness of prosthesis, and the complications were evaluated postoperatively. RESULTS: In the 20 eyes that underwent enucleation, the preoperative axial length was 6.8~16.6 mm (mean 12.4 mm) and the axial length of the enucleated globes was 9.0~20.0 mm (mean 15.3 mm). The size of implants was 16.5~20.0 mm (mean 19.5 mm). In the 10 eyes that underwent evisceration, the preoperative axial length was 13.5~22.7 mm (mean 19.1 mm). The size of the implants was 18.5~20.0 mm (mean 19.4 mm). During a follow-up period of 6-30 months (mean 16.0 months), none of the eyes showed any complications such as conjunctival dehiscence or implant exposure or extrusion. CONCLUSIONS: The preoperative axial length measurement was helpful in deciding if enucleation or evisceration of the phthisis bulbi should be performed. Evisceration was performed sufficiently in cases of a preoperative axial length of 16 mm or more.

Lymphoscintigraphy of Eyeball and Ocular Adnexal Malignant Tumors

PURPOSE: To evaluate the usefulness of preoperative or postoperative lymphoscintigraphy for the identification of lymphatic drainage and sentinel lymph node in patients with eyeball and ocular adnexal malignant tumors. METHODS: Lymphoscintigraphy was performed preoperatively or postoperatively in 5 patients with biopsy proven primary eyeball or ocular adnexal malignant tumors. Patients underwent lymphoscintigraphy with 500 micro Ci of technetium-99m antimony trisulfide colloid in a volume of 0.1 ml. We injected intradermally either the outer 1/3 of the upper or lower lid, or the inner 1/3 of the upper or lower lid. Images were taken by Gamma camera and we checked lymphatic drainage and sentinel lymph nodes. RESULTS: Two patients with conjunctival malignant melanoma showed normal lymphatic drainage, but the other two patients had lymphatic drainage to the parotid and submandibular chain, and sentinel lymph nodes were noted as the parotid lymph node and the submandibular lymph node. The patients with sebaceous gland carcinoma injected in the outer 1/3 of the upper lid had submandibular lymphatic chain and the sentinel lymph node proved to be the submandibular lymph node. CONCLUSIONS: Lymphoscintigraphy demonstrated the lymphatic drainage system and successfully identified the sentinel lymph nodes. This should prove to be very helpful to evaluate metastasis of the eyeball and ocular adnexal malignant tumors by selective lymph node biopsy and to decide the degree of surgery.

The Surgical Efficacy of External Lacrimal Surgery without Nasal Mucosal Flap

PURPOSE: To evaluate the surgical result of lacrimal surgery with total removal of the nasal mucosal flap. METHODS: Lacrimal surgery was performed in 30 eyes of 26 patients, by external approach without the nasal mucosal flap from February 2001 to August 2002. The surgical method was similar to conventional dacryocystorhinostomy, but the nasal mucosa of the osteotomy site was removed with a No.11 Bard-Parker blade and Westcott scissors. After insertion of a silicone tube, the anterior flap of the lacrimal sac was sutured to the soft tissues around the osteotomy site. Surgical efficacy was evaluated after a follow-up period of 7 22 months (average, 11.5 months). RESULTS: The primary success rate was 96.7% (29/30 eyes). We performed revision of mucosa ostium in the one failed eye, thereby raising the final success rate to 100%. The size of mucosa ostium was 0.7 3.0 mm (average 1.17 mm). CONCLUSIONS: Satisfactory surgical results were obtained without anastomosis of the lacrimal sac or the nasal mucosa during external approach, lacrimal surgery. We suggest that this method is a good surgical procedure in external approach, lacrimal surgery.

Treatment of Orbital and Ocular Adnexal Malignant Lymphoma

PURPOSE: The aim of this study was to evaluate the clinical features, histologic classification and treatment outcomes of patients with malignant lymphoma of the eye. METHODS: The participants included 22 patients with malignant lymphoma of the orbit and ocular adnexa treated at our hospital between May 1994 and September 2001. The authors retrospectively analyzed the sex, age, location of mass, histopathologic type, stage and results of the treatment. RESULTS: Of the 22 patients, 14 cases were male and 8 were female. The age ranged from 26 to 68 years (mean age 43 years). The most common presenting complaint was slowly growing mass of the eye. Histopathologic studies revealed extranodal marginal zone B-cell lymphoma, MALT type in 20 cases (91%). The stages of lymphomas were included I AE in 14 cases (63%), II AE in 3 cases (14%), III AE in 3 cases (14%) and IV A in 2 cases (9%). Patients received radiotherapy and/or chemotherapy. Twenty out of 22 cases (91%) achieved a complete remission. During the mean follow-up of 26 months, two patients died of progression of the disease; one patient had extranodal marginal zone B-cell lymphoma, MALT type of stage III AE and the other patient had diffuse large cell lymphoma of stage II AE. CONCLUSIONS: Radiotherapy can produce durable remission in the majority of the patients with localized primary orbital lymphoma. Chemotherapy should be performed for the patients with highly malignant lymphomas or lymphomas with systemic manifestations.

Mutational Analysis of FOXL2 Gene in Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome (BPES) Patients

PURPOSE: The purpose of this paper is to identify the forkhead transcription factor gene (FOXL2) mutations in Korean patients with blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). METHODS: We have analyzed the mutations of FOXL2 gene in genomic DNAs extracted from 16 BPES patients and their families by PCR, PCR-SSCP, and sequencing. RESULTS: No deletion in exon 1 to 3 of the FOXL2 gene was observed by PCR. The PCR products were subjected to SSCP analysis and 9 patients showed SSCP shifts. The PCR products showing SSCP shifts were subcloned into plasmid vectors and sequenced to confirm the FOXL2 mutation. In total, 7 mutations (1 nonsense mutation, 1 deletion, and 5 duplications) in exon 2 were identified. CONCLUSIONS: The FOXL2 gene mutations were identified in the Korean BPES patients. Some of the mutations were previously reported and some were new mutations. This study will contribute to the molecular analysis and clinical counseling of BPES patients.

The Effect of Mitomycin C on Cultured Human Osteoblasts

PURPOSE: To evaluate the effect of mitomycin-C (MMC) on osteotomy site as an adjunctive therapy for dacryocystorhinostomy, the effect of MMC on cultured human osteoblasts was tested. METHODS: Cultured osteoblasts which was obtained from the human iliac crest, were treated with four different concentrations of MMC (0 mg/ml, 0.2 mg/ml, 0.02 mg/ml, 0.002 mg/ml) and cultured for 24hours. To observe the effect of exposed time dependency, cells were treated with MMC during 5, 30minutes, and 24hours and washed and changed with fresh osteogenic media, and then cultured for 24 hours. The effect of fibroblast growth factor (FGF) and transforming growth factor-beta(TGF-beta) on the MMC-treated cells was evaluated. Cell viability was measured using trypan blue staining method and MTT assay. RESULTS: As compared with control group, the lowest growth rate of osteoblasts was 6.8% in 0.2 mg/ml MMC-treated cells. There were no significant differences in the growth rate between 5 minutes and 30 minutes MMC treatment groups, but in case of 24 hours treatment group with MMC (0.2 mg/ml) the growth rate was suppressed to 77.5% of control group with statistical significance. Both growth factors had promotive effect on the growth of in 0.02 mg/ml MMC-treated osteoblasts, but not in 0.2 mg/ml MMC-treated cells. CONCLUSIONS: Osteoblasts which were treated for longer time and with higher concentration of MMC showed more suppression in growth rate. These results suggest that intraoperative application of MMC during dacryocystirhinostomy could have a positive effect of mucosal ostium with suppression of osteoblasts proliferation.

External Levator Resection in Mild to Moderate Unilateral Ptosis

PURPOSE: The ideal goal of the surgery for mild or moderate unilateral ptosis is to obtain symmetric palpebral fissure. The purpose of this paper is to evaluate the surgical outcome of mild or moderate unilateral ptosis patients after the procedure of external levator resection. METHODS: External levator resection with aponeurotic approach was performed on 25 mild to moderate unilateral ptosis patients with less than 2 mm MRD difference from June 1997 through May 2000. Outcome was defined as good, fair, and poor. RESULTS: Of the patients, 21 patients had congenital ptosis and 4 patients revealed acquired ptosis. Ten patients were male and 15 were female. Age ranged from 3 to 58 years(mean 19.8 years). Amount levator resection was 8~15 mm (mean 11.2 mm) with mild overcorrection. After the follow-up period 6~30 months (mean 10.8 months), 18 patients (72%) showed good results. Three patients (12%) revealed fair, and poor results were noted in 4 patients (16%). Patients with good and fair results were satisfied aesthetic aspect. CONCLUSIONS: Based on this study, mild overcorrection of levator resection was one of the ideal procedures for mild to moderate unilateral ptosis patients.

Surgical Efficacy of Probing with Silicone Intubation for Lacrimal Apparatus Obstruction in Children

PURPOSE: The surgical efficacy of probing with silicone tube intubation for congenital and acquired lacrimal obstruction was investigated. METHODS: Medical records of 51 children (55 eyes) with lacrimal obstruction were reviewed. Twentyfive children (28 eyes) had congenital obstruction and 26 children (27 eyes) had acquired lacrimal obstruction. Age ranged from 13 to 78 months (mean 29.8 months). All of the children were examined preoperatively by dacryocystography and treated with probing and silicone tube intubation with or without inferior turbinate fracture. RESULTS: After the follow-up period of 6~41 months (mean 13.2 months), primary success rate of probing and silicone tube intubation was 88.1% (30/37 cases) : 88.9% (16/18 cases) in congenital obstruction and 73.3% (14/19 cases) in acquired obstruction. After combined inferior turbinate fracture and silicone tube intubation, success rate noted 100% in both congenital and acquired cases. The success rates showed 100% in the cases with maintenance period of silicone intubation over 16 weeks and 65.0% in the cases with maintenance period of silicone intubation under 16 weeks. The success rates revealed no statistical significance in etiology, age, obstruction site and lacrimal sac size. CONCLUSIONS: For congenital and acquired lacrimal apparatus obstruction in children, dacryocystography, probing, internal fracture of the inferior turbinate and silicone intubation should be maintained more than 16 weeks.

The Effect of Mitomycin C in Endonasal Dacryocystorhinostomy

PURPOSE: To evaluate the effect of intraoperative 0.2 mg/ml mitomycin C application on the success of endonasal dacryocystorhinostomy. METHODS: One hundred patients (121 eyes) were randomly divided into two groups. Group A (50 patients, 59 eyes) was treated with 0.2 mg/ml mitomycin C application during endonasal dacryocystorhinostomy and group B (50 patients, 62 eyes) was operated without application of mitomycin C. In group A, mitomycin C soaked cotton swabs were applied to the osteotomy site for five minutes. The surgical success was defined as either symptom free from epiphora or good passage of syringing. RESULTS: After the follow-up period of 6~24 months (mean 10.2 months), average diameter of mucosal osteum measured 1.17+/-0.52 mm in group A and 1.00+/-0.61 mm in group B. Granuloma around mucosal osteum was noted in 20 eyes of group A and in 31 eyes of group B. Primary success rate was 93.2% in group A and 82.3% in group B. There was no significant difference in mucosal osteum size or success rate between the two groups. CONCLUSIONS: Adjunctive use of intraoperative mitomycin C may be useful to maintain larger osteotomy size and provide better success rate of endonasal dacryocystorhinostomy.

Surgical Results in Asymmetric Congenital Ptosis

PURPOSE: Achieving good eyelid position and symmetric palpebral fissure for asymmetric bialteral congenital ptosis would require skillful technique and a lot of experiences of surgeon. Patients were divided into two groups, A and B, in terms of preoperative MRD and the possible relationship between preoperative MRD difference. The outcome of the surgery was studied. METHODS: External levator resection with apponeurotic approach was performed for 19 patients with asymmetric bilateral congenital ptosis from October 1994 to June 2000. According to differences of MRD between the both eyes, patients were divided into two groups. Group A included 8 patients with 1.0~2.0 mm of MRD differences, and group B included 11 patients with more than 2.0 mm of MRD differences. RESULTS: Age of patients ranged from 3 to 20 years (mean 6.1 years) and follow-up period was 9 to 60 months (mean 20 months). Six patients of group A and seven patients of group B showed almost excellent symmetric palpebral fissure. Only one patient of group B had postoperative MRD difference more than 2.0 mm, and none in group A. CONCLUSIONS: Success rate was 100% in group A and 91% in group B, but no statistical difference was found between group A and group B (p>0.05).

Effects of Mitomycin C on Cultured Rabbit Osteoblasts

PURPOSE: To evaluate the effect of mitomycin C (MMC) on osteotomy site as an adjunctive therapeutic agent during dacryocystorhinostomy, the effect of MMC on cultured rabbit osteoblasts was tested. METHODS: Cultured osteoblasts which was obtained from the iliac crest of rabbits, were treated with MMC (0.2 mg/ml) for 5 or 30 minutes, washed and changed with fresh osteogenic media (Opti-MEM), and then cultured for 24 hours. To observe the effect of MMC dose dependency on cultured osteoblasts, four different concentrations of MMC (0.2 mg/ml, 0.02 mg/ml, 0.002 mg/ml, 0.0002 mg/ml) were applied into the cells and cultured for 24 hours. The effect of fibroblast growth factor (FGF) and transforming growth factor-beta(TGF-beta) on the MMC-treated cells was evaluated. In control group, osteoblasts were cultured in osteogenic media without exposure of MMC for 24 hours. Cell viability was measured using trypan blue staining method. RESULTS: As compared with control group, the growth of osteoblasts was inhibited by MMC (0.2 mg/ml) treatment, 30-minute treatment group demonstrated marked suppression twice as much as 5-minute treatment group. Growth rate of 0.2 mg/ml MMC-treated cells was highly suppressed to 7.7% of control and 0.02 mg/ml MMC-treated cells was inhibited to 15.4% in number. Growth rate of 0.002 mg/ml, 0.0002 mg/ml MMC-treated cells was diminished to 53.8%, 84.6% in number, respectively. Both growth factors had promotive effect on the growth of osteoblasts in 0.002 mg/ml MMC-treated cells, especially in TGF-beta. CONCLUSION: Osteoblasts which were treated for longer time and with higher concentration of MMC showed more severe suppression in growth rate. These results suggest that MMC could have some therapeutic effect on osteotomy site of dacryocystorhinostomy.

Surgical Efficacyin the Upper and Lower Eyelid Retraction

Medical records of 27 patients(34 eyes)with upper and lower eyelid retraction were reviewed to evaluate the surgical efficacy from September 1987 through September 1999 at the Department of Ophthalmology, Yeungnam University College of Medicine. The causes of 23 patients(28 eyes)with the upper eyelid retraction revealed ptosis overcorrection(12 eyes), thyroid ophthalmopathy(7 eyes), trauma(6 eyes)and congenital deformity(3 eyes). Recession of upper eyelid retractors was performed in all cases and combined M u llerectomy was carried out in 4 eyes of thyroid ophthalmopathy. Preserved sclera was used as a spacer in 2 eyes. For the 4 patients(6 eyes)with lower eyelid retraction, recession of lower eyelid retractors was performed and preserved sclera was used in 4 eyes. After the follow-up periods of 6 to 60 months(mean 27 months), 25 eyes(89%)of the upper eyelid retractions and all of the 6 lower eyelid retractions showed good cosmetic appearance. Postoperative problems included asymmetry of upper eyelid contour(1 eye), overcorrection(4 eyes), and undercorrection(2 eyes). Advancement of levator aponeurosis was performed in 2 overcorrected cases with good result. Recession of the upper or lower eyelid retractors with or without M u llerectomy allowed satisfactory appearance for the patients with upper and lower eyelid retraction. Spacer material of the preserved sclera was used for the patients with severe eyelid retraction.

The Surgical Efficacy of External Dacryocystorrhinostomy

PURPOSE: To evaluate the success rate of conventional skin dacryocystorhinostomy(DCR), the success rate and postoperative complications were evaluated after the follow-up period of 6~72 months(average 16.7 months), and compared with those of our previous reports on endonasal DCR, at postoperative 6 months(PO6M) and 12 months(PO12M). METHODS: skin DCR was performed in 76 patients, 89 eyes between July 1993 and June 2000 at the Department of Ophthalmology, Yeungnam University College of Medicine. RESULTS: Primary success rate of skin DCR was 93.3%, and the final success rate after revision of mucosal ostium revealed 96.6%. Postoperative complications included 7 cases of silicone tube protrusion and 4 cases of mucosal ostium obstruction. CONCLUSIONS: Primary success rate of skin DCR was 93.3%, and those of endonasal DCR were 92.3%(PO6M) and 89.8%(PO12M). The final success rate of skin DCR was 96.6%, and those of endonasal DCR were 98.4%(PO6M) and 99.2%(PO12M).

The Effect of Mitomycin C(MMC) on Sinus Mucosal Openings in Rabbits

PURPOSE: This experimental study investigates the effect of mitomycin C(MMC) on the healing of sinus mucosal opening. METHODS: One hundred and twenty rabbits were used and divided into 8 groups of fifteen rabbits. A small(1.35 mm) or large(2.7 mm) diameter mucosal opening was created by drilling in the medial wall of the left maxillary sinus of rabbits and treated with MMC at a concentration of 0.2 or 2.0 mg/ml for 5 or 30 minutes. Five rabbits from each group were sacrificed at 1,2 & 4 weeks. The size of a remained mucosal opening was measured and light and electron microscopic examination were performed. RESULTS: After comparing the sizes of remained mucosal openings among the small opening groups(group 1,3 & 5), group 5 maintained larger opening at 2 weeks than the control group(P<0.05). Light microscopy of the specimens showed inflammatory and degenerative changes. The bone of the maxillary sinus exhibited minimal change induced by MMC. Scanning electron micrographs showed heterochromatin in nuclei and mitochondrial swelling of the epithelium. CONCLUSIONS: The MMC was effective in maintaining a larger mucosal opening than control group at least for 2 weeks following surgery.

Long Term Surgical Efficacy of Endonasal Dacryo cys torhinostomy

Primary success rate of endonasal dacryocystorhinostomy has been reported lower than that of conventional cedure. Gradual stenosis of mucosal ostium would progress until 6 to 10 months following operation and a longterm follow-up should be necessary. Endonasal dacryocystorhinostomy was performed in 100 patients[118 eyes]between July 1993 and March 1998 at the Department of Ophthalmology, Yeungnam University College of Medicine. After the follow-up period of 1 to 4 years[average 16.2 months], longterm success rate, postoperative omplications, and factors to affect success rate were studied. The success rate of primary operation was 89.83%, and the success rate after secondary revision of the ostium was up to 99.15%. Granulation tissue formation was the most common postoperative complication, and other complications included protrusion of silicone tube, membranous obstruction, partial obstruction of common canaliculus, canaliculitis and prolapse of orbital fat. Factors to obtain good success rate were careful and acurate surgical technique to achieve large mucosal ostium, postoperative management, antibiotics and steroid medication, etc. Long-term surgical efficacy of endonasal dacryocystorhinostomy was similar to skin approach and secondary success rate following revision was very satisfactory.