不同部位阻塞性泪道疾病激光泪道成形术疗效观察

目的:比较KTP激光泪道成形术治疗不同部位阻塞性泪道疾病的远期疗效.方法:阻塞性泪道疾病共587眼,根据阻塞部位的不同分组,激光泪道成形术后均连续使用易妥芬眼液冲洗泪道,对比分析各组远期疗效.结果:KTP泪道激光在泪道阻塞性疾病的治疗中不同阻塞部位的疗效间存在差异,下泪小点、泪小(总)管阻塞组的治疗有效率高于单纯鼻泪管阻塞及慢性泪囊炎组.结论:KTP泪道激光对泪小点、泪小(总)管阻塞效果很好,对单纯鼻泪管阻塞的病例也有一定的疗效,但足在慢性泪囊炎的病例中复发率较高.对于长期慢性泪囊炎的患者,我们建议选择泪囊鼻腔吻合术.     

激光泪道成形术治疗阻塞性泪道疾病的疗效观察

目的　观察掺钕钇铝石榴石激光泪道成形术治疗阻塞性泪道疾病的疗效 ,并对泪道不同阻塞部位的疗效进行分析。方法　采用掺钕钇铝石榴石激光泪道成形术治疗 6 0 3例 (6 93只眼 )阻塞性泪道疾病患者 ,按泪道阻塞的部位分为泪小点阻塞 (2 3只眼 )、泪小 (总 )管阻塞 (192只眼 )、鼻泪管阻塞 (2 2 7只眼 )、慢性泪囊炎 (2 31只眼 )及外伤性泪小管离断 (2 0只眼 ) 5组 ,术后定期冲洗泪道 ,平均随访 1 5年 ,将各组疗效进行对比分析。结果　泪小点阻塞、泪小 (总 )管阻塞、鼻泪管阻塞、慢性泪囊炎及外伤性泪小管离断组的治愈率和有效率分别为 86 9%和 95 7%、89 1%和 93 8%、93 0 %和96 0 %、78 4 %和 82 7%及 4 0 0 %和 6 5 0 %。经Ridit分析 ,各组 R±S R 分别为 0 92 1± 0 0 2 3、0 914±0 0 0 9、0 92 7± 0 0 0 7、0 85 6± 0 0 13及 0 74 9± 0 0 5 5。慢性泪囊炎组疗效低于鼻泪管和泪小 (总 )管阻塞组 (P <0 0 5 ) ;外伤性泪小管离断组疗效低于其他 4组 (P <0 0 5 )。结论　掺钕钇铝石榴石激光泪道成形术治疗鼻泪管阻塞效果最好 ,其他依次为泪点、泪小 (总 )管阻塞、慢性泪囊炎及外伤性泪小管离断 ,但应严格掌握适应证。     

新型泪道支撑管逆行置管联合泪道激光治疗慢性泪囊炎及泪道阻塞

目的 观察泪道激光后运用新型泪道支撑管逆行置管及碘必舒眼膏治疗慢性泪囊炎及泪道阻塞的效果.方法 127例(139眼)其中:慢性泪囊炎55眼、鼻泪管阻塞52眼、泪小管及鼻泪管阻塞23眼、单纯泪小管阻塞9眼.先用倍频Nd:YAG激光疏通泪道阻塞部位后,将新型硅胶泪道支撑管表面涂碘必殊眼膏后逆行置入阻塞的泪道部位.结果 术后随访6～12个月,治愈104眼,好转27眼,无效8眼.结论 新型泪道支撑管逆行置管联合泪道激光及碘必舒眼膏治疗慢性泪囊炎及泪道阻塞,操作简单、手术安全、疗效可靠、组织损伤小、皮肤不留瘢痕、且可重复手术.     

KTP泪道探通术加透明质酸钠置留治疗泪道阻塞

我院自 2 0 0 0年 7月～ 2 0 0 0年 10月 ,采用倍频 YAG激光(即 KTP— ND:YAG激光 ,简称 KTP激光 )治疗各种泪道阻塞 18例 19眼 ,治疗效果报告如下 :材料和方法 :( 1)对象 :18例 19眼中 ,男性 4例 ,女性 14例。年龄 9至 65岁 ,病程半年至 8年 ,19眼中泪小点阻塞 2眼 ,泪小管阻塞 6眼 ,泪总管阻塞 2眼、鼻泪管阻塞 3眼 ,慢性泪囊炎 4眼 ,泪囊鼻腔吻合手术后不通 2眼。 ( 2 )设备 :1武汉华工激光工程有限责任公司生产的带导光纤维 KTP泪道激光 ,波长为 5 3 2 nm,脉冲频率为 3 0 0 0— 5 0 0 0 pps,输出功率 8—15 W可调 ,用 0 .3— 0 …     

泪道激光联合新型泪道支架植入治疗鼻泪管阻塞

目的：探讨Nd:YAG激光联合新型泪道支架植入治疗鼻泪管阻塞的疗效。 方法：鼻泪管阻塞者26例29眼在激光泪道疏通后,植入新型泪道支架。术后定期冲洗泪道。 结果：随访9～12mo,治愈22眼,好转5眼,总有效率93％。无效2眼（7％）。 结论：泪道激光联合新型泪道支架治疗鼻泪管阻塞操作安全简便,对组织损伤小,是治疗鼻泪管阻塞、慢性泪囊炎的有效方法。     

激光泪道成形术治疗阻塞性泪道疾病1384例的疗效分析

目的 观察掺钕钇铝石榴石(neodymium-yttrium aluminum garnet, Nd:YAG)激光泪道成形术治疗阻塞性泪道疾病的疗效,并对泪道不同阻塞部位的疗效进行分析.方法 采用Nd:YAG激光泪道成形术治疗1 384 例(1 707眼) 阻塞性泪道疾病患者,按泪道阻塞的部位分为泪小点阻塞(35眼)、泪小管阻塞(625眼)、泪总管阻塞(598 眼)和鼻泪管阻塞(449 眼).术后定期冲洗泪道,随访6个月至3年,将各组疗效进行对比分析.结果 泪小点阻塞、泪小管阻塞、泪总管阻塞及鼻泪管阻塞组的治愈率分别为74.3%、40.0%、36.1 %和31.8 %,有效率分别为94.3 %、57.9%、51.2 %和43.8 %.结论 单纯Nd:YAG激光泪道成形术治疗泪小点阻塞效果最好,而治疗泪小管阻塞、泪总管阻塞及鼻泪管阻塞组的效果欠佳.(中国眼耳鼻喉科杂志,2009,9:101-102)     

Nd：YAG激光治疗泪道阻塞的疗效观察

目的 评价Nd:YAG激光治疗泪道阻塞的疗效.方法 对460例(483跟)泪道阻塞患者均采用Nd:YAG激光手术治疗.结果 术后随访6月以上,泪点闭锁10眼治愈10眼(100%);泪点闭锁合并泪小管阻塞3眼,治愈2眼,好转1眼(100%);泪总管、泪小管阻塞169眼治愈145眼,好转5眼,有效率89.35%;鼻泪管阻塞263眼治愈240眼,好转5眼,有效率93.16%;慢性泪囊炎38眼,治愈9眼,好转5眼,有效率36.84%.483眼总治愈率为84.06%,总有效率97.58%.结论 泪道激光治疗泪道阻塞具有无痛苦、损伤小和疗效好等特点,值得推广.     

泪道激光联合置管术治疗泪道阻塞性疾病的疗效观察

目的: 观察激光联合泪道置管治疗泪道阻塞性疾病疗效。方法: 泪道阻塞性疾病患者79例96眼,27眼(22眼泪小管、泪总管阻塞,5眼泪小管合并鼻泪管阻塞)行激光联合泪道引流管植入术;69眼(27眼鼻泪管阻塞,42眼慢性泪囊炎)行激光联合鼻泪管支架植入术。术后给予激素、抗生素眼药水点眼1wk,泪道引流管术后3～6mo顺利拔管,鼻泪管支架,4wk拔管,所有患者随访12mo。结果: 泪道引流管,鼻泪管支架取出后随访12mo,泪溢消失者79眼,泪溢好转者10眼,无效者7眼,泪溢但无脓,总有效率为93%,显效率82%。结论: 根据泪道阻塞部位选择泪道激光联合不同硅胶管植入是治疗泪道阻塞性疾病简便有效的方法,值得在基层医院推广。     

Nd:YAG激光治疗不同部位泪道阻塞的临床疗效分析

目的: 分析Nd:YAG激光治疗泪道阻塞的临床疗效以及对不同阻塞部位的有效率的分析。方法: 对2009-02/2011-12我院门诊840例920眼不伴有泪囊炎的泪道阻塞患者,均采用Nd:YAG脉冲激光机治疗,其中泪小管阻塞134眼,鼻泪管阻塞786例眼,术后行连续4d妥布霉素地塞米松或复方硫酸新霉素滴眼液泪道冲洗。分别对单纯泪小管和鼻泪管阻塞患者进行3mo随访。结果: 总有效率76.2%,其中泪小管阻塞有效94眼,有效率70.1%。鼻泪管阻塞有效607眼,有效率77.2%,单纯鼻泪管阻塞患者的有效率高于单纯泪小管阻塞患者。结论: Nd:YAG激光治疗单纯泪道阻塞(不伴泪囊炎)具有理想的疗效,方法简单易行,有效率高,患者痛苦小,并发症少,花费少,无效患者后续可选替代治疗方案多,可以作为单纯泪道阻塞疾病的首选方案。激光泪道成形术对单纯鼻泪管阻塞患者的有效率略高于单纯泪小管阻塞。     

逆行置入泪道再通管治疗慢性泪囊炎及鼻泪管阻塞

目的 探讨逆行置入泪道再通管治疗慢性泪囊炎及鼻泪管阻塞的疗效.方法 对73例(77眼)慢性泪囊炎及鼻泪管阻塞采用进口硅胶制成的泪道再通管逆行置入鼻泪管中,恢复其自然通道.结果 73例(77眼)中,治愈61例(65眼),有效9例(9眼),无效3例(3眼),总治愈有效率96.10%.结论 逆行置入泪道再通管治疗慢性泪囊炎及鼻泪管阻塞成功率高,面部无瘢痕,出血少,手术时间短.     

KTP激光击射后植入胶原泪栓治疗泪点闭锁

目的探讨泪点闭锁用KTP激光击射后植入可溶性胶原泪栓的疗效.方法对21例(23眼)泪点闭锁用KTP激光击通闭锁的泪点后,用显微平镊将可溶性胶原泪栓植入泪点内.结果21例(23)眼经1次激光联合可溶性胶原泪栓治疗后均无溢泪症状,随访3～6月.泪点形成,泪道冲洗通畅.本组病例均治愈.结论KTP激光击射后再植入胶原泪栓是治疗泪点闭锁的一种有效的方法.     

泪道激光加置泪道引流管治疗泪道阻塞的疗效分析

目的:观察泪道激光治疗后置入泪道引流管的疗效。方法:激光疏通泪道后,分别由上下泪小点插入泪道硅胶管,由下鼻道捞出硅胶管并打结留置3mo。结果:共治疗1070例,泪溢消失者共518例,泪溢好转者283例,无效者269例,总有效率为71.68%。结论:泪道激光加置泪道引流管可提高泪道激光治疗的成功率。     

激光泪小点成形术/泪小点切开术联合泪道置管治疗泪小点狭窄

目的:分析我院激光泪小点成形术/泪小点切开术联合泪道插管治疗泪小点狭窄的可行性、适应证及疗效。方法:回顾性分析我院2009-01/2010-06门诊确诊并行手术的泪小点狭窄或膜闭病例37例41眼。其中20例22眼行Nd:YAG激光泪小点成形联合置管术,17例19眼行泪小点切开联合置管术。拔管后随访3～12mo,随访时观察、记录患者的溢泪情况、泪小点形态和功能恢复情况及手术并发症情况。结果:截至末次随访,两种术式的有效率均为100%,激光联合置管术的治愈率为82%;切开联合置管术的治愈率为79%,两种术式的治愈率未见明显差异。先天性泪小点闭锁的治愈率为100%。泪点周围组织红肿伴眼痒者2例;泪小点撕裂者1例;泪道肉芽增生者1例。无引流管自行滑脱病例。结论:激光泪小点成形术/泪小点切开术联合泪道置管治疗泪小点狭窄疗效肯定。激光联合置管术治疗泪小点狭窄或膜闭手术操作简便,可作为常规术式进行推广。先天性泪小点闭锁可视为切开联合置管术的手术适应证。     

顺行法泪道插管与单纯泪道冲洗治疗泪道阻塞疗效比较

目的:通过比较顺行式泪道插管与单纯泪道冲洗治疗的疗效,探讨治疗泪道阻塞的方法。方法:对泪道阻塞患者140例140眼随机分为观察组和对照组,其中观察组75眼行顺行式泪道插管,单纯泪道冲洗组65眼对照眼,术后随访6～12mo。结果:观察组治愈65眼,治愈率86.7%,复发1眼,对照组治愈45眼,治愈率69.2%,复发2眼,两组治愈、复发率比较均有显著性。结论:顺行法程氏泪道插管术具有操作简单、方便易行、经济实用等优点,该项治疗泪道阻塞方法的方法适于在基层医院推广。     

泪道内镜下治疗泪道阻塞性疾病的初步观察

目的 探讨泪道内窥镜对泪道阻塞性疾病的治疗效果,并比较泪道激光和微型电钻对阻塞部位的探通治愈率和并发症发生率.方法 前瞻性随机对照临床试验.2006年9至12月在华中科技大学同济医学院附属协和医院眼科对89例(104只眼)上泪道阻塞(包括泪小管阻塞、泪总管阻塞)(PSCO)与鼻泪管阻寒(NLDO)的患者于局部麻醉下使用泪道内镜进行泪道检查,了解泪道黏膜和阻塞情况,针对阻塞部位进行激光或微型电钻处理,泪道冲洗通畅后,注入0.3%妥布霉素+0.1%地塞米松眼膏.术后随访9～12个月,观察疗效与并发症,比较激光与微型电钻对不同阻塞部位治疗的效果和应用特点.疗效与并发症分析采用χ2检验.结果 89例患者的泪道阻塞状况和部位均能被有效观察.术中泪道阻塞再通率为100.00%(104/104),术后随访治愈率78.85%(82/104).PSCO和NLDO治愈率分别为77.78%(42/54)、80.00%(40/50)(χ2=0.077,P=0.782).激光和微型电钻治愈率分别为80.43%(37/46)、77.59%(45/58)(χ2=0.125,P=0.724).泪道激光治疗PSCO、NLDO治愈率分别为89.66%(26/29)、64.71%(11/17)(χ2=4.239,P=0.040),微型电钻治疗PSCO、NLDO治愈率分别为64.00%(16/25)、87.88%(29/33)(χ2=4.664,P=0.031).激光治疗组和微型电钻治疗组术中出血发生率分别为10.87%(5/46)、55.17%(32/58)(χ2=21.969,P=0.000),激光治疗组和微型电钻治疗组术中眼睑水肿发生率分别为4.35%(2/46)、6.90%(4/58)(χ2=0.017,P=0.896).结论 泪道内镜能在直视下对泪道阻塞性疾病进行精确观察和针对性治疗.针对不同阻塞部位选择不同治疗方法将有助于提高患者手术效果.     

泪道内镜下治疗泪道阻塞性疾病的初步观察

Objective To evaluate the therapeutic efficacy of lacrimal endoscope treatment for lacrimal passage obstruction, and to compare the effectiveness of endoscopically controlled laser surgery and micro-drill surgery for lacrimal passage obstruction. Methods It was a prospective random controlled trial. Eighty nine patients (104 eyes) with lacrimal passage obstruction, including presaccal canalicular obstruction (PSCO) and nasolacrimal duct obstruction (NLDO), were collected from September 2006 to December 2006 in Department of Ophthalmology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. Patients were examined by endoscopy of the lacrimal drainage system under local anesthesia to detect the obstruction and changes of lacrimal mucous membrane. The obstructions were treated with laser or microdrill. Irrigation was performed to prove the recanalization of the lacrimal passage followed by injected ointment with 0.3% tobramycin and 0.1% dexamethasone into the lacrimal passage. All patients were followed up after the operation for 9-12 months. The difference between the laser and the microdrill treatment was observed. Chi-square test was used to evaluate the curative effect and complications differences between these two groups. Results The obstruction scene in the lacrimal passage of 89 patients could be observed effectively. All obstructions (104/104 eyes) were eliminated after the operation. Through the follow-up, the cure rate reached 78.85% (82/104 eyes). The cure rate of PSCO group and NLDO group, reached 77.78% (42/54 eyes) and 80.00% (40/50 eyes), respectively (χ2=0.077,P=0.782). The cure rate of laser group and micro-drill group, was 80.43% (37/46 eyes) and 77.59% (45/58 eyes), respectively (χ2=0.125,P=0.724). The cure rate of laser treatment was 89.66% (26/29 eyes) in the PSCO group and 64.71% (11/17 eyes) in the NLDO group (P=0.040). The cure rate of micro-drill treatment was 64.00% (16/25 eyes) in the PSCO group and 87.88% (29/33 eyes) in the NLDO group (χ2=4.664,P=0.031). Hemorrhage and palpebral edema occurred in 10.87% (5/46 eyes) and 4.35% (2/46 eyes) after laser treatment, respectively. Percentage of hemorrhage and palpebral edema after the micro-drill treatment was 55.17% (32/58 eyes) (compared to the laser group, χ2=21.969,P=0.000) and 6.90% (4/58 eyes) (compared to the laser group, χ2=0.017 ,P=0.896). Conclusions Lacrimal passage obstruction can be observed and treated directly through the endoscopy of lacrimal drainage system. Choosing an appropriate surgical procedure according to the locations of the obstruction can be helpful for improving the effectiveness of the operation.     

泪道内镜下治疗泪道阻塞性疾病的初步观察

Objective To evaluate the therapeutic efficacy of lacrimal endoscope treatment for lacrimal passage obstruction, and to compare the effectiveness of endoscopically controlled laser surgery and micro-drill surgery for lacrimal passage obstruction. Methods It was a prospective random controlled trial. Eighty nine patients (104 eyes) with lacrimal passage obstruction, including presaccal canalicular obstruction (PSCO) and nasolacrimal duct obstruction (NLDO), were collected from September 2006 to December 2006 in Department of Ophthalmology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. Patients were examined by endoscopy of the lacrimal drainage system under local anesthesia to detect the obstruction and changes of lacrimal mucous membrane. The obstructions were treated with laser or microdrill. Irrigation was performed to prove the recanalization of the lacrimal passage followed by injected ointment with 0.3% tobramycin and 0.1% dexamethasone into the lacrimal passage. All patients were followed up after the operation for 9-12 months. The difference between the laser and the microdrill treatment was observed. Chi-square test was used to evaluate the curative effect and complications differences between these two groups. Results The obstruction scene in the lacrimal passage of 89 patients could be observed effectively. All obstructions (104/104 eyes) were eliminated after the operation. Through the follow-up, the cure rate reached 78.85% (82/104 eyes). The cure rate of PSCO group and NLDO group, reached 77.78% (42/54 eyes) and 80.00% (40/50 eyes), respectively (χ2=0.077,P=0.782). The cure rate of laser group and micro-drill group, was 80.43% (37/46 eyes) and 77.59% (45/58 eyes), respectively (χ2=0.125,P=0.724). The cure rate of laser treatment was 89.66% (26/29 eyes) in the PSCO group and 64.71% (11/17 eyes) in the NLDO group (P=0.040). The cure rate of micro-drill treatment was 64.00% (16/25 eyes) in the PSCO group and 87.88% (29/33 eyes) in the NLDO group (χ2=4.664,P=0.031). Hemorrhage and palpebral edema occurred in 10.87% (5/46 eyes) and 4.35% (2/46 eyes) after laser treatment, respectively. Percentage of hemorrhage and palpebral edema after the micro-drill treatment was 55.17% (32/58 eyes) (compared to the laser group, χ2=21.969,P=0.000) and 6.90% (4/58 eyes) (compared to the laser group, χ2=0.017 ,P=0.896). Conclusions Lacrimal passage obstruction can be observed and treated directly through the endoscopy of lacrimal drainage system. Choosing an appropriate surgical procedure according to the locations of the obstruction can be helpful for improving the effectiveness of the operation.