Endonasal dacryocystorhinostomy with mucosal flaps

PURPOSE: To describe a new endonasal dacryocystorhinostomy (DCR) technique and assess its efficacy. DESIGN: Prospective nonrandomized interventional case series. METHODS: A prospective series of 44 consecutive endonasal DCRs performed from January 1999 to December 2000 was entered into the study. The new technique involved creation of a large bony ostium and mucosal flaps to create an anastamosis between the lacrimal sac mucosa and nasal mucosa. Patients presenting with naso-lacrimal duct obstruction based on symptomatic, clinical, and radiologic grounds were included in the study. Patients who had undergone previous lacrimal surgery were excluded. Surgery was performed by two surgeons (A.T., P.J.W.) using a standardized operative technique. Patient demographics, presentation, examination findings, surgical and anesthetic data, postoperative success, complications, and follow-up were evaluated. Success was defined as anatomic patency as well as relief of symptoms as assessed by fluorescein flow on nasendoscopy, lacrimal syringing, and patient examination. Intubation of the lacrimal apparatus was performed in all operations and the tubes usually removed at 4 to 6 weeks postoperatively. After removal of the tubes follow-up was 13 months (mean, 12.9 months; range, 9-28 months; standard deviation [SD], 6.1 months). RESULTS: There were 36 patients (12 male/24 female) who underwent 44 endonasal DCRs. The average age of the patients was 62.9 years old (range, 15-86 years old; SD, 19.1 years) and the main presentation was with epiphora (93%) and/or mucocoele (33%). In 13 operations (30%) a septoplasty was required at the time of surgery, and in 10 operations (23%) further endoscopic sinus surgery was performed in conjunction with the DCR. Anatomic success with a patent nasolacrimal system was achieved in 40 of 44 operations (91%). Symptomatic and anatomic success was seen in 39 of 44 operations (89%). Five of the DCRs were classified as failures. In one DCR the patient was symptomatic despite a patent nasolacrimal system and well-healed ostium. In two DCRs preoperative medial canalicular problems were noted. In two DCRs scarring and fibrosis of ostium were noted. CONCLUSIONS: This new technique of endonasal DCR involves creation of a large ostium and construction of nasal and lacrimal sac mucosal flaps. Its anatomic success rate (91% or 40 of 44 DCRs) compares favorably with the success rate of other techniques for endonasal DCR and is also similar to the success of external DCR. Experience in endoscopic nasal surgery is important in endonasal DCR surgery, as other ancillary procedures may be required within the nose at the time of surgery.     

Outcome of external dacryocystorhinostomy combined with membranectomy of a distal canalicular obstruction

PURPOSE: To investigate the accuracy of the preoperative evaluation in identifying a membranous obstruction of the distal canaliculus and the success rate of an external dacryocystorhinostomy (DCR) when membranectomy of the canalicular obstruction is also performed. DESIGN: Retrospective, interventional case series. METHODS: The surgical records of the lacrimal cases operated at Moorfields Eye Hospital between January 1997 and December 1999 were reviewed. All the patients with evidence of a membranous block of the canalicular opening into the sac identified and excised during the course of a standard DCR procedure with silastic intubation and a minimum follow-up period of 12 months were selected for this study. The records were analyzed for preoperative evaluation with syringing and probing, surgical details, outcome, and complications. RESULTS: In 59 (85%) cases a functional anastomosis was established after tube removal. Additionally, 5 cases (7%) had patent system but required later ectropion repair and considered successful. Only 4 (6%) patients needed further lacrimal surgery, and one was referred to the ENT department for nasal polyps. The silastic tube was removed at a mean period of 6 weeks (SD = 4; range, 2-24 weeks), and the mean follow-up period was 13 months (SD = 3; range, 12-29 months). The preoperative evaluation failed to identify the membranous obstruction in 30 (43%) cases, which were correctly diagnosed intraoperatively. CONCLUSIONS: In our series the anatomic success rate of 92% after DCR with membranectomy is comparable to the outcome of the DCR procedure. The distal canalicular membranous obstruction is an anatomic factor that may lead to surgical failure if not identified and excised.     

Outcome of patients with nasolacrimal polyurethane stent implantation: do they keep tearing?

PURPOSE: To evaluate the results of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction and the effects of obstructed nasolacrimal stent on subsequent dacryocystorhinostomy (DCR). METHODS: This study was designed as a nonrandomized, prospective clinical trial. Stent implantation was attempted in 53 obstructed lacrimal drainage systems of 47 patients. Stent placement was performed in a retrograde fashion through the external nare over a guide wire, which was introduced from the upper punctum. Occluded stents were removed either with nasal endoscopy or during DCR. External DCR surgery with silicone intubation was performed in cases with stent failure. RESULTS: The mean follow-up period was 23.4 months. The success rate of stent implantation was 60.4%, 37.5%, and 31.2% at 6-, 12-, and 18-month follow-up, respectively. Stent obstruction developed in 33 eyes. Twenty underwent external DCR with silicone intubation. During DCR surgery, varying degrees of chronic inflammatory reaction were detected in the lacrimal sac and nasolacrimal duct. The mean follow-up period after DCR was 10.3 months. Epiphora was relieved with DCR in all but one eye. CONCLUSIONS: The success rate of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction is low and may induce inflammation and fibrous tissue formation. Although this may cause further difficulties in subsequent lacrimal surgery, epiphora could be relieved with meticulous technique.     

Paediatric dacryocystorhinostomy

Of 258 cases of dacryocystorhinostomy performed on children in the period September 1981 to September 1991, 130 were for simple, unresolved congenital nasolacrimal duct obstruction. Other indications for surgery included punctal agenesis, lacrimal fistula, post-traumatic and post-inflammatory canalicular obstruction. Of 177 children without canalicular pathology, 171 (96%) were relieved of symptoms with one operation, without canalicular intubation. Of 81 cases with canalicular disease, 55 of 70 (79%) who underwent DCR plus canalicular intubation, and 10 of 11 who underwent DCR plus Lester-Jones tube, were substantially improved with one operation. No child required peroperative or postoperative blood transfusion. Dacryocystorhinostomy in childhood, in experienced surgical hands, is a safe procedure, achieving relief of symptoms in most cases, particularly in the absence of canalicular disease.     

Mechanical endonasal dacryocystorhinostomy versus external dacryocystorhinostomy

PURPOSE: To compare the success rates of a new mechanical endonasal dacryocystorhinostomy (MENDCR) technique and the conventional external dacryocystorhinostomy technique (Ext-DCR). METHODS: A prospective, nonrandomized interventional comparative case series of 31 consecutive MENDCRs and 24 Ext-DCRs performed from January 1999 to December 2000. Patients with anatomic nasolacrimal duct obstruction were included in the study; previous lacrimal surgery and functional nasolacrimal and canalicular obstruction were exclusion criteria. Two surgeons performed the MENDCRs, using a standardized operative technique, which involved creation of a large bony ostium and mucosal flaps between the lacrimal sac mucosa and nasal mucosa. One surgeon performed all Ext-DCRs. RESULTS: Twenty-seven patients (8 men, 19 women) underwent 31 MENDCRs. The average age of the patients was 62.9 years (range, 15 to 86 years; SD, 19.1 years). In 11 cases (35.4%), a septoplasty was required at the time of surgery, and in 6 cases (19%), further endoscopic sinus surgery was performed. In the Ext-DCR group, 23 patients (7 men, 16 women) underwent 24 DCRs. The average age was 59.6 years (range, 22 to 86 years; SD, 18.5 years). No other nasal procedures were performed at the time of surgery in this group. The average follow-up time was 13 months for the MENDCR group and 12.4 months for the Ext-DCR group. Success was defined as relief of symptoms and by anatomic patency, which was assessed by history, fluorescein flow on nasal endoscopy, and lacrimal syringing. In the MENDCR group, surgery was successful in 29 of 31 DCRs (93.5%); 1 of 2 failed cases was anatomically patent but symptomatic, yielding an anatomic patency rate of 96.8%. In the Ext-DCR group, the success rate was 95.8% (23/24 DCRs); the failed case was anatomically patent but symptomatic, giving an anatomic patency rate of 100%. The differences in overall success and anatomic patency were not statistically significant (P = 0.6 and P = 0.56, 1-tailed Fisher exact test). CONCLUSIONS: The success rate of MENDCR (93.5%) compares favorably with that of standard external DCR (95.8% in this study). MENDCR relies on the creation of a large ostium and mucosal flap apposition. A larger, randomized prospective trial is needed to fully assess the efficacy of this new technique.     

Computerized survey of lacrimal surgery patients

A computerized survey of 295 patients undergoing lacrimal drainage surgery within a three-year period where a six-month follow-up was possible was undertaken. The etiology and demographic information regarding tear duct obstruction was assessed. Dacryocystorhinostomy surgery was found to be highly successful (93%), in obstructions of the lacrimal sac and lacrimal duct. The overall success rate in patients with canalicular and common canalicular obstruction undergoing a reconstructive approach was 73%, and those cases where an attempt was made to relieve epiphora with the insertion of a Jones bypass tube had a success rate of 65% on one operation. Most of these Jones tube patients could ultimately be rendered tear-free.     

Endoscopic repair of failed dacryocystorhinostomy

Primary dacryocystorhinostomy (DCR) failure is commonly due to scarring at the rhinostomy site. Nasolacrimal duct obstruction due to scarring may also occur in patients who have had their lacrimal bone removed during maxillary sinus surgery. Five patients following DCR and 3 patients after sinus surgery, all with constant epiphora, underwent endoscopic reconstruction of their lacrimal drainage system. Preoperatively, patency of the bony ostium was determined either by computed tomographic (CT) scan or dacryocystography. Endoscopically, the lacrimal drainage system was reopened then intubated with a silastic stent. Any scar tissue was visualized endoscopically and resected. Seven of the 8 patients have been followed from 3 to 24 months after stent removal, and all have had relief of their epiphora. Endoscopic repair is a useful adjunct in the management of patients with DCR failure or patients with epiphora after removal of the lacrimal bone during sinus surgery. This brief procedure can be performed under local anesthesia, does not require a skin incision, and allows the evaluation and correction of intranasal pathology.     

Dacryocystorhinostomy for epiphora in the presence of a patent lacrimal system

Purpose : To evaluate the success rate of dacryocystorhinostomy (DCR) for epiphora in patients with a clinically patent lacrimal drainage system. Methods : A series of 51 patients, 12 men and 39 women, who underwent DCR surgery for epiphora with a clinically patent lacrimal drainage system in the background of normal eyelid examination, were evaluated. All patients underwent fluorescein dye disappearance testing and Jones 1 and 2 testing with dacryocystograms in borderline cases. A standard DCR was performed with bicanalicular silicone tubing inserted in all cases. The average time for the removal of the silicone tubes was 9.6 weeks. Results : In 48 cases (94%) there was improvement in symptoms with minimal or no significant epiphora postoperatively. Conclusions : Epiphora with a patent lacrimal drainage system obstruction can be successfully treated by DCR based on fluorescein dye disappearance tests and Jones 1 and 2 tests, with dacryocystography in borderline cases.     

Results of the application of intraoperative mitomycin C in dacryocystorhinostomy

PURPOSE: Dacryocystorhinostomy (DCR) is widely accepted as the procedure of choice for surgical correction of lacrimal drainage system obstruction distal to common canaliculus in adulthood. The success rate of DCR has been reported to be from 63% to 99%. DCR failure has been attributed to membranous occlusion of the rhinostomy site caused by soft tissue scarring. More recently, use of mitomycin C (MMC) has been described in lacrimal drainage surgery. The beneficial effect of MMC as a surgical adjunct is thought to be related to its potent inhibition of fibroblast proliferation. METHODS: To improve the success rate of DCR, the authors used MMC as an adjunct to surgery in 130 patients with nasolacrimal duct obstruction undergoing lacrimal surgery. They were assigned randomly into a MMC DCR group and a regular DCR group (control group). RESULTS: The mean age of the MMC group was 40+/-15 years and that of the control group was 42+/-16 years. The standard surgical techniques of an external DCR were used in all patients of both groups. Patients were followed for 6 months. The authors evaluated the patients with subjective symptoms (improvement in tearing) and objective findings such as the height of tear meniscus, fluorescein dye test, and patency at the time of irrigation. There was no significant difference in the age between the two groups (p=1.00). Six patients in the mitomycin group were symptomatic after 6 months' follow-up; probe and irrigation showed non-patency of lacrimal system. The success rate in the MMC group was therefore 90.5% (59/65), and in the conventional group it was 92.4% (60/65). No significant difference between the two groups was present (p=0.75). CONCLUSIONS: The authors conclude that the use of intraoperative MMC in DCR surgery does not change the success rate of this procedure.     

Effect of timing of external dacryocystorhinostomy on surgical outcome

PURPOSE: To present our experience with external dacryocystorhinostomy (DCR) outcome and to compare cases of early and late DCR. METHODS: Retrospective data review of all patients who had external DCR with silicone intubation in a 7-year period. Data were collected and analyzed concerning patients' preoperative and postoperative symptoms, and the lacrimal drainage system examination before, during, and after surgery. RESULTS: In all, 162 patients underwent 195 DCR surgeries for nasolacrimal duct obstruction. Success was achieved in 81% of surgeries. Success rates were higher in patients who had early DCR (tearing only or early inflammatory signs of the lacrimal sac, 84% success) than in cases that had late DCR (more than 6 months after inflammation started, 77% success). These differences were statistically insignificant. Failure of DCR was much higher in posttraumatic DCR than in DCR for other etiologies. Complications (in 9% of surgeries) were generally mild and infrequent, except 1 case of meningitis. CONCLUSIONS: In experienced hands, external DCR has good postoperative success with a low complication rate. Early DCR does not have a substantial advantage over late surgery with regard to surgical outcome.     

改良式外路泪囊鼻腔吻合术联合泪道置管治疗泪囊黏液囊肿

目的:探讨改良的外路泪囊鼻腔吻合术式联合泪道置管治疗泪囊黏液囊肿的临床疗效.方法:对23例(23眼)泪囊黏液囊肿行改良式泪囊鼻腔吻合术,并联合泪道置管,术后行泪道冲洗,并观察泪溢情况.结果:23例患者,1例术中改为泪囊摘除术,20例完成12个月的追踪观察治疗,1例术后6个月失访,1例12个月时失访.随访1个月,22例患者术后泪囊囊肿均消失,外观明显改善;随访12个月,20例患者中18例溢泪症状完全消失,所有患者泪道冲洗通畅,仅1例患者因泪溢症状对手术疗效不满意.结论:改良式外路泪囊鼻腔吻合术联合泪道置管治疗泪囊黏液囊肿,具有良好的临床效果,值得推广.     

Surgical Outcomes of Canalicular Trephination Combined with Endoscopic Dacryocystorhinostomy in Patients with Distal or Common Canalicular Obstruction

PurposeThis study investigated the surgical outcomes of canalicular trephination combined with endoscopic dacryocystorhinostomy (DCR) in patients with a distal or common canalicular obstruction. It also identified the factors affecting surgical success rates associated with this technique.MethodsWe retrospectively reviewed the medical records of 57 patients (59 eyes) in whom a canalicular obstruction was encountered during endoscopic DCR. All patients were treated with endoscopic DCR, followed by canalicular trephination and silicone tube placement. The surgical outcome was categorized as a functional success according to the patient''s subjective assessment of symptoms, including epiphora, and as an anatomical success according to a postoperative nasolacrimal duct irrigation test. Surgical success rates were compared based on age, sex, location of the obstruction, number of silicone tubes, and experience of the surgeon.ResultsFunctional success was achieved in 55 of 59 eyes (93%) at one month, 50 eyes (84%) at three months, and 46 eyes (78%) at six months. Anatomical success was achieved in 58 of 59 eyes (98%) at one month, 52 eyes (88%) at three months, and 50 eyes (84%) at six months. There was a statistically significant difference in surgical outcome according to the experience of the surgeon. The anatomical success rate at the six-month follow-up exam was 95.4% in the >5 years of experience group, and 53.3% in the <5 years of experience group (p = 0.008, Pearson chi-square test).ConclusionsThe success rate of canalicular trephination combined with endoscopic DCR in patients with a distal or common canalicular obstruction decreased gradually during the six-month follow-up period. In particular, patients undergoing procedures with experienced surgeons tended to show excellent surgical outcomes at the six-month follow-up exam.     

鼻内镜下泪道磷酸钾钛激光在复发性泪囊炎中的应用

目的 探讨鼻内镜引导下泪道磷酸钾钛（KTP）激光在治疗复发性泪囊炎的应用效果.方法 复发性泪囊炎35例（35眼）采用鼻内镜直视下泪道KTP激光成形术,术中植入泪囊型支架,合并泪管阻塞者植入泪道引流管,3个月后取出支架及引流管,术后随访半年至1年.结果 35例（35眼）,治愈32例（32眼）,好转1例,无效2例,有效率,94.29％.出现炎症反应1例,占2.86％.结论 鼻内镜引导下泪道KTP激光治疗复发性泪囊炎可提高手术成功率,创伤更小.但也出现了再次阻塞的病例.     

泪道置管术治疗泪道阻塞的疗效及影响因素

目的:探讨泪道成形术联合硅胶置管术治疗泪道阻塞的疗效以及影响因素。方法:2012-05/12在我院门诊就诊的泪道阻塞患者141例146眼,行泪道成形术联合泪道硅胶引流管治疗,术后随诊3～6mo,观察泪道再通率以及泪道阻塞的部位、患者年龄以及病程对手术效果的影响。结果:患者141例146眼中总的治愈率为82.9%(121眼),好转率13.7%(20眼),无效率3.4%(5眼)。其中,泪总管阻塞的治愈率(87.2%)高于泪小管阻塞的(82.9%)以及鼻泪管阻塞的(75.9%),但差异没有统计学意义(χ2=2.20,P=0.69)。青年组治愈率为(88.4%)高于中老年组(82.4%)和老年组(75.9%),但差别也没有统计学意义(χ2=2.56,P=0.63)。病程<10a的治愈率为93.8%,而病程≥10a的治愈率为74.4%,差别有统计学意义(χ2=9.58,P=0.009)。结论:泪道成形术联合泪道置管术是治疗泪道阻塞简单有效的方法,患者的病程可能是影响治愈率的主要因素。     

泪道内镜下环钻术治疗复发性上泪道阻塞的临床研究

目的 探讨在泪道内镜下行环钻术治疗复发性上泪道阻塞的方法及其临床疗效.方法 回顾性系列病例研究.收集2007年2月至2008年2月南京医科大学第二附属医院眼科67例(73只眼)复发性上泪道阻塞患者的病历资料.患者局部麻醉后在泪道内镜下通过检查确定阻塞性质和部位,然后采用微型环钻清除泪道阻塞物并置人硅胶管治疗,拔管后随访6个月,观察疗效.结果 术后3～5个月,73只眼均顺利拔管.其中51只眼(69.86%)治愈,即无流泪,泪道冲洗通畅;19只眼(26.03%)好转,即轻微流泪,泪道冲洗通,但不畅;3只眼(4.11%)无效,即仍流泪,泪道冲洗不通.有效率为95.89%(70/73).且上下泪小管阻塞合并鼻泪管阻塞的有效率低于单纯下泪小管阻塞或泪总管阻塞.结论 泪道内镜下环钻术是一种安全、有效的治疗复发性上泪道阻塞的手术,可明显提高治疗复发性上泪道阻塞的成功率.     

鼻内镜下泪小管开放治疗近端泪小管阻塞的疗效

目的:探讨鼻内镜下泪小管开放联合引流管置入治疗近端泪小管阻塞的可行性、有效性、安全性。方法:收集2016-06/2018-06在我院眼科确诊的近端泪小管阻塞患者52例61眼,均行经鼻入路鼻内镜下泪小管开放联合引流管置入术,引流管在泪道内留置2~3mo后拔除,术后随访6~12(平均7.3±2.2)mo,观察手术疗效及并发症情况。结果:所有患者术中均顺利开放泪小管,并顺利置入引流管。末次随访,52眼治愈(85%),5眼好转(8%),4眼无效(7%),总有效率93%,术中、术后均未发生全身及局部严重并发症。结论:鼻内镜下泪小管开放联合引流管置入术治疗近端泪小管阻塞,术中可以精准定位泪小管阻塞段并充分开放正常段,成功率高,安全可行。     

Transcanalicular-endonasal semiconductor diode laser-assisted revision surgery for failed external dacryocystorhinostomy

PURPOSE: To report the results of transcanalicular-endonasal revision dacryocystorhinostomy (DCR) with a semiconductor diode laser in cases of failed external DCR. DESIGN: Prospective, nonrandomized, interventional case series. METHODS: Fifteen cases in 13 patients with failed external DCR underwent transcanalicular-endonasal DCR with a semiconductor diode laser. A functional successful outcome was defined as a patent nasolacrimal drainage system in nasolacrimal irrigation and a resolution of the symptomatic epiphora and/or mucoid discharge. RESULTS: The patients were followed for a mean postoperative period of 27.3 months (range, nine to 54 months). The mean duration of the surgery was 19.6 minutes. After the initial revision transcanalicular-endonasal DCR surgery, patency to irrigation was obtained in 12 cases (80%), and 15 cases (100%) after a second revision treatment. Three cases required repeated revision surgery, and three other cases were considered to be functional failures in spite of a patent lacrimal system after the final revision surgery. The overall functional success rate was 80% (12 cases) at the final examination (mean, 27.3 months after surgery), and there were no intraoperative and postoperative complications. The presence of a canalicular obstruction or granulation tissue was not significantly related to the success rates of the revision surgery. The length of time between the primary and revision surgery, gender, age, the duration of the first revision surgery, and the timing of stent removal were also not significantly related to the failed cases. CONCLUSION: Transcanalicular-endonasal DCR is a minimally invasive procedure and is recommended for patients as an alternative procedure for failed external DCR.     

The efficacy of sleeve technique in primary nasolacrimal duct obstruction with a high lacrimal sac

Purpose:

To evaluate the efficacy of a sleeve technique during endoscopic dacryocystorhinostomy (DCR) in primary nasolacrimal duct obstruction (NLDO) patients with a high lacrimal sac.

Materials and Methods:

The medical records of 45 patients (49 cases) undergoing endoscopic DCR for primary NLDO with a high lacrimal sac were retrospectively reviewed. In 19 patients (21 cases), the thick maxilla covering the common canalicular opening was removed using a drill and a bicanalicular silicone tube was inserted (group 1). In 26 patients (28 cases), instead of removal of the thick maxilla, a sleeve was inserted into the bicanalicular silicone tube (group 2). At 6 months postoperatively, the success rate was evaluated and the size of the intranasal mucosal ostium was measured.

Results:

The success rates in group 1 and 2 was 90.5% and 96.4%, respectively (P =0.400). The intranasal mucosal ostium in group 1 and 2 measured 1.7 ± 0.7 mm and 3.1 ± 1.0 mm, respectively, and the difference was significant (P =0.042).

Conclusions:

In primary NLDO patients with a high lacrimal sac, DCR inserting a silicone tube and a sleeve together had a satisfactory success rate without using a drill. In comparison with traditional surgical methods, it helped enlarge the size of the intranasal mucosal ostium.     

Lacrimal drainage capacity and symptomatic improvement after dacryocystorhinostomy in adults presenting with patent lacrimal drainage systems

AIM. To determine the rate of symptomatic improvement after dacryocystorhinostomy (DCR) in patients with epiphora and insignificant obstruction to preoperative lacrimal syringing, and to measure the conductance of the postoperative lacrimal drainage anastomosis. METHODS. Retrospective cohort study of patients with symptomatic epiphora and patent tear ducts, with at least two-year follow-up after DCR. Patients underwent structured telephone interview together with clinical examination for lacrimal drainage capacity using the saline drop test.(1) RESULTS. Thirty-seven of 383 adult patients having had DCR were noted to have patent tear ducts at preoperative examination. Ten patients with previous surgery were excluded and two other patients were excluded because of other factors contributory to epiphora. Of the remaining 25 patients, 22 (aged 35-75 years at surgery; median 56 years) underwent a structured telephone interview: Of the 13 (60%) who felt that symptoms had improved, 9 (41%) were relieved of indoor epiphora and 11 (50%) thought the procedure was an overall success. Seventeen patients underwent clinical examination. The lacrimal drainage anastomosis was patent in all patients and the saline drop test result was well within the normal range in 3/4 patients who had persistent indoor epiphora. CONCLUSION. Of patients with epiphora due to minor nasolacrimal duct stenosis, open DCR produces a marked improvement or cure of symptoms in 50%. The lacrimal drainage capacity was well within the normal range in 3/4 patients with persistent postoperative lacrimal symptoms, suggesting that other factors (such as hypersecretion) may be significant in this group of patients with 'functional block'.     

泪道重建联合Ritleng泪道插管术治疗儿童继发性泪道阻塞

目的 评估泪道重建联合Ritleng泪道插管手术治疗儿童结膜炎后继发性泪道阻塞的效果。方法 回顾性系列病例研究。分析2008年7月至2013年12月利用泪道重建联合Ritleng泪道插管治疗的结膜炎致继发性泪道阻塞连续病例43例（49眼）的临床资料。其中男20例（23眼）,女23例（26眼）,年龄8个月至11岁。所有病例采用全身麻醉下泪道重建联合Ritleng泪道插管手术治疗,根据病情于术后2~6个月拔管,术后随访6～12个月。拔除泪道硅胶管后,泪道冲洗通畅为治愈,泪道冲洗通不畅并偶有流泪为好转,泪道不通为治疗无效。结果 术中探查按阻塞部位分为泪小管阻塞（9眼）、泪总管阻塞（12眼）、鼻泪管阻塞（4眼）、两处及以上部位阻塞（24眼）。拔管后治愈32眼（65%）,好转10眼（20%）,无效7眼（14%）。鼻腔出血及鼻翼肉芽肿为主要并发症,分别占28%、41%,对症处理后均痊愈。结论 泪道重建联合Ritleng插管技术是一种简便、安全和有效的治疗儿童结膜炎后继发性泪道阻塞的手术方法。