KTP激光联合新型泪道引流管治疗泪道阻塞

目的:观察KTP激光联合新型泪道引流管治疗各种原因所致的泪道阻塞。方法:用带针芯的泪道探针探察泪道阻塞处,拨出针芯,再插入KTP激光纤维,发射激光,消除阻塞,疏通泪道,冲洗通畅,用泪道引流管两端分别自上下泪点进入,疏通泪道至鼻腔,两端稍拉紧至鼻孔,至此处打死结,减除多余软管,管结弹回鼻腔。术后点抗生素眼液,3mo后取管。结果:各种原因所致泪道阻塞426例482眼,手术成功445眼(92.3%),失败37眼(7.7%)。结论:KTP激光联合泪道引流管治疗泪道阻塞,操作简便,适应证广,组织损伤小,术后无瘢痕,患者无痛苦,门诊即可手术,时间在5min左右即可完成。     

经泪小点泪道内窥镜治疗难治性泪道阻塞性疾病

目的:探讨经泪小点泪道内窥镜治疗难治性泪道阻塞性疾病的疗效,评价其临床应用价值。方法:难治性泪道阻塞患者29例(32眼)于局麻下使用经泪小点泪道内窥镜系统进行泪道检查,并针对阻塞部位进行激光或电钻处理,泪道冲洗通畅后,注入3g/L妥布霉素+1mg/g地塞米松眼膏,术后随访6mo观察疗效。结果:全部患眼泪道均能被有效观察,术中再通率100%,术后随访治愈20眼(62%),好转5眼(16%),无效7眼(22%)。结论:经泪小点泪道内窥镜能对难治性泪道阻塞性疾病进行有效观察,并能进行有效的针对性治疗。     

激光指示光引导鼻内镜下手术治疗外伤性鼻泪管阻塞伴泪囊移位

目的 观察通过激光指示光引导定位泪囊，行鼻内镜下泪囊鼻腔吻合手术治疗泪囊移位的方法。方法 对12例（12眼）经CT、MRI或泪囊造影后证实泪骨、鼻骨、或上颌骨鼻突骨折造成鼻泪管阻塞和泪囊移位，在局麻下激光指示光针于上或下泪小管进入泪囊，鼻内镜光源反复打开和关闭以观察指示光最靠近骨窗的最佳位置，切开相应鼻黏膜，做骨窗，然后顺势扩大鼻黏膜和骨窗口，准确找到泪囊后放入泪囊鼻腔引流支架。结果 12眼外伤性鼻泪管阻塞伴泪囊移位采用上述方法均顺利完成泪囊鼻腔吻合手术，术中大大减少了手术探查寻找泪囊带来的鼻黏膜和骨组织过多的损伤，术中患者痛苦少，术后恢复快，鼻腔换药次数减少。结论 激光指示光引导行鼻内镜下泪囊鼻腔吻合手术其定位准确，操作简单，组织损伤少，手术时间短。     

Lacrimal drainage system endoscopic examination and surgery through the lacrimal punctum.

BACKGROUND: To describe an approach to restore the physiological tear passages of an obstructed lacrimal drainage system with instruments introduced through one of the lacrimal punctum. METHOD: In a first step a miniature endoscope (?: 0.9, 1.1, 1.3 mm) is introduced in one of the lacrimal punctum to visualize the level, the extent, and the nature of an obstruction along the lacrimal drainage system. In a second step, the miniature endoscope is replaced by a lacrimal trephine (?: 0.9, 1.1, 1.3 mm) that holds an optic fiber in its lumen, and the obstruction is removed under endoscopic visual control. The entire procedure is performed under local anesthesia. RESULTS: With this approach it is possible to visualize and remove partial or total fibrous obstructions along the lacrimal drainage system (lacrimal canaliculus, nasolacrimal duct). Lacrimal sac lithiasis can also be fragmented and eliminate in the nose through the nasolacrimal duct. During or after the procedure only minor, and no major, complications can sometime occur, such as hematoma or edema (after lacrimal irrigation) of the surrounding soft tissues. CONCLUSION: The approach described here is straight forward, quick, and can be performed under visual endoscopic control and in local anesthesia. With this approach partial stenosis can easily be diagnosed and cured. This procedure might potentially change our current concepts regarding surgical indications for obstructive epiphora and dacryocystitis. However, the long-term results of this type of surgery need to be challenged.     

Endoscopy of the lacrimal system

BACKGROUND/AIM: Until recently, diagnosis of disorders of the lacrimal system has depended on digital dacryocystography and on clinical examinations such as the fluorescein dye test, lacrimal probing, and irrigation. The lacrimal system and its mucous membranes can now be viewed directly with a lacrimal endoscope. While the first endoscopes were rigid and limited by poor picture quality in axial illuminations, the new generation of endoscopes are a great leap forward for new diagnostic and therapeutic approaches. METHODS: 132 patients ranging in age from 8 months to 73 years with nasolacrimal obstruction were referred to the lacrimal department. Diagnostic lacrimal imaging utilising various small calibre endoscopes less than 0.5 mm in external diameter was performed. The endoscopes are coupled to specially designed lacrimal probes as well as a CCD camera and a video recorder. The imaging was performed during standard lacrimal probing and irrigation in an outpatient clinic setting in 120 of 132 patients RESULTS: All patients reported the pain of endoscopy as being similar to that of standard lacrimal probing and irrigation. No adverse effects such as bleeding or lacrimal perforation were noted. Endoscopic manipulation was not too difficult and the picture quality, depth of focus, and illumination were satisfactory in all cases. The most common site of stenosis was the nasolacrimal duct (59 patients), followed by the lacrimal sac (39 patients) and the canaliculi (34 patients). In 25 patients, partial obstruction, rather than complete stenosis, was visualised as a narrow lumen, which widened during irrigation. In 14 of 28 patients, obstruction was due to canalicular submucosal folds and was removed with laser. In addition, the colour and consistency of the lining mucosa correlated with type of obstruction. Normal mucosa is smooth and light pink in colour. Inflammatory changes manifest as thickened and reddish grey mucosa. More complete stenosis is shown as fibrotic plaques with grey white inelastic membranes. CONCLUSION: Lacrimal endoscopy is a new, non-invasive method used to view directly and localise obstructions precisely. It allows differentiation between inflammatory, partial, and complete stenosis. Endoscopy enables one to choose the appropriate surgical therapy for patients. Patients tolerated the procedure well without any adverse reactions or effects. While it may not replace standard probing and irrigation, this technique is an extremely useful adjunct in determining the proper surgical modality, ease, and tolerance of the endoscopic manipulation by patients, and obtaining sharp and clear images of the nasolacrimal outflow system anatomy and pathology. Differentiation of various types of obstruction by precise location and severity can be achieved.     

激光联合不同硅胶管植入治疗不同部位泪道阻塞的疗效

目的：：观察激光联合新型一次性使用泪道再通管( RS型)或泪道扩张引流管(鼻泪管)治疗不同部位泪道阻塞疾病的疗效。方法：针对2011-01/2013-12我院548例657眼泪道阻塞患者,其中泪小管(含泪总管)阻塞患者236例298眼,采用KTP激光联合泪道再通管( RS型)植入术;鼻泪管阻塞患者312例359眼,采用KTP激光联合泪道扩张引流管(鼻泪管)植入术,术后坚持泪道冲洗,手术3 mo后拔除支架,以拔管后3 mo冲洗泪道情况及患者自觉溢泪情况作为评定标准。结果：泪小管(或泪总管)阻塞的患者行KTP激光联合新型RS型泪道再通管植入术,其中治愈248眼,好转33眼,无效17眼;鼻泪管阻塞的患者行KTP激光联合泪道扩张引流管植入术,其中治愈301眼,好转19眼,无效39眼。有效601眼,总有效率91.5％。结论：泪道阻塞患者治疗过程中需制定个性化治疗方案,针对泪道不同部位阻塞激光联合不同硅胶管植入经临床观察疗效肯定,可作为基层医院泪道阻塞患者首选治疗方式。     

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.     

KTP泪道激光探通術加透明質酸鈉置留治療泪道阻塞

目的通過KTP激光臨床應用,觀察KTP激光探通術加透明質酸鈉置留治療各種原因所致的泪道阻塞的治療效果.方法用帶針芯的泪道探針探查泪道至阻塞處,拔出針芯,再插入KTP激光導光纖維,發射激光,清除阻塞,疏通泪道.注入透明質酸鈉置留.結果各種原因泪道阻塞19眼,手術成功18眼,失敗1眼.結論 KTP激光探通術加透明質酸鈉置留能有效地治療各種泪道阻塞.     

A surgical approach to treat chronic epiphora and/or muculopurulent discharge in patients with permeable lacrimal drainage system

BACKGROUND: This study reports the one-year success rate of a new surgical approach to treat symptoms of chronic epiphora and/or mucopurulent discharge refractive to at least six months of medical treatment in patients with permeable lacrimal drainage system (irrigation test). PATIENTS AND METHODS: Design: retrospective chart review analysis. Participants: seventeen consecutive patients referred from a private praxis to an eye clinic to treat, by surgery, symptoms of either chronic epiphora (8/17), mucopurulent discharge (7/17), or both (2/17). Intervention: Piffaretti's non-laser transpunctal endoscopic diagnostic/surgical lacrimal drainage procedure (17/17), lacrimal punctoplasty (16/17), conjunctivochalasisplasty (5/17), lateral canthoplasty (1/17), and/or both conjunctivochalasisplasty and lateral canthoplasty (3/17). In the majority of these patients (13/17) partial obstructions within the lacrimal canaliculus (3/17), the ductus nasolacrimalis (7/17), or both (3/17) were observed endoscopically and removed with Piffaretti's lacrimal trephines. Main outcome measures: patient's self-assessment of symptom improvement one year after surgery. RESULTS: One year after surgery, 88 % (15/18) of patients had a marked improvement of their symptoms, 64 % (11/17) of them even reporting as being symptom free. When conducted (14/17), irrigation always revealed a permeable lacrimal system (test not performed in a lost-to-follow-up and in two symptom-free patients). CONCLUSIONS: Surgery can be an alternative therapeutic option for patients who have a permeable lacrimal drainage system and suffer from chronic epiphora and/or mucopurulent discharge that do not respond to conventional conservative medical therapies.     

Transcanalicular diode laser-assisted dacryocystorhinostomy

Objective:

We present a prospective, non-comparative case series study of 126 consecutive diode laser-assisted transcanalicular dacryocystorhinostomy (TCL-DCR) procedures on 122 patients. We analyzed success rate, procedure time and amount of laser energy needed for a 5 mm osteotomy.

Materials and Methods:

One hundred and twenty-two patients with nasolacrimal duct obstruction were included in the study. The procedure was performed under general anesthesia, and the nasal mucosa was anesthetized. An endoscope was used for examination of the lacrimal pathways. The site of osteotomy was determined with transillumination of the lateral nasal wall. We achieved osteotomy by applying laser energy via an optic fiber. We used a 980 nm diode laser with power of 10 Watts. We inserted a bicanalicular silicone stent as the last step. Success of procedure was absence of epiphora (subjective), or patency of the lacrimal drainage system on irrigation (objective).

Results:

We performed 126 successive endoscopic laser (EL-DCR) with bicanalicular intubation in 122 patients. The average procedure time was 12 min, and on average 245 Joules of laser energy was needed. The silicone stents were removed three to eight months after surgery. We observed absence of epiphora and a patent nasolacrimal duct on irrigation in 105 out of 126 treated eyes. Eighteen patients had epiphora despite a patent nasolacrimal duct on irrigation. This yields a success rate of 83.3%, with an average follow-up period of 12 months.

Conclusions:

The 980 nm EL-DCR with bicanalicular intubation is a new contribution to the field of lacrimal surgery. It is a minimally invasive quick procedure yielding a high success rate.     

YAG激光联合RS引流管置入治疗泪道阻塞疗效影响因素分析

目的：探讨YAG激光联合RS引流管治疗泪道阻塞的疗效及独立影响因素。

方法：回顾性分析2015-01/2018-01在我院行激光联合引流管置入治疗的250例泪道阻塞患者病例资料,总结术后疗效并采用Logistic回归分析影响疗效的独立因素。

结果：患者术后临床治疗总有效率为87.9%; 病程(OR=8.654,95% CI：3.740～20.023)、泪道冲洗频率(OR=3.480,95% CI：2.128～5.691)、泪道阻塞长度(OR=0.518,95% CI：0.238～1.131)、拔管时间(OR=0.386,95% CI：0.237～0.628)以及首次手术(OR=14.717,95% CI：10.798～20.059)是影响患者术后疗效独立影响因素。

结论：YAG激光联合RS引流管置入治疗泪道阻塞疗效显著,早期治疗、避免多次手术、术后适度冲洗泪道、控制拔管时间,均有利于提高疗效。     

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。     

Treatment of nasolacrimal duct obstruction in adults with polyurethane stent

PURPOSE: To evaluate the efficacy of polyurethane nasolacrimal duct stents in the treatment of epiphora resulting from primary acquired nasolacrimal duct obstruction in adults. MATERIALS AND METHODS: In 25 patients (21 women and four men with mean age of 44 years, range 20 to 74 years) with nasolacrimal duct obstruction, 28 hollow polyurethane stents designed by Song and associates were placed under fluoroscopic guidance. The obstruction was complete in 20 lacrimal drainage systems and partial in eight. The lacrimal sac size was normal or large on dacryocystogram in all lacrimal drainage systems. A Ritleng probe was introduced through the upper punctum and advanced past the obstruction. A guide wire with a flexible tip was then introduced through the probe, over which the stent was advanced in retrograde fashion and placed into the lacrimal sac and nasolacrimal duct. Clinical success was defined by the demonstration of a completely patent lacrimal drainage pathway through saline irrigation and no or minimal complaint of epiphora. RESULTS: Stent placement was technically successful in 26 of 28 lacrimal drainage systems (93%). The mean time of fluoroscopy screening was 3.2 minutes (range, 1.4 to 5.8 minutes). The overall success rate was 82% (23 of 28 lacrimal drainage systems). Two stents were completely occluded. In one lacrimal drainage system with minimal epiphora, the stented drainage pathway was partially occluded. The patients were followed up from 4 to 22 months (mean, 7.2 months). CONCLUSIONS: Retrograde placement of a hollow polyurethane nasolacrimal duct stent is a technique that is simple and well tolerated by patients. This method achieves a high success rate and may be suggested as a nonsurgical procedure for adults with primary nasolacrimal duct obstruction and proper lacrimal sac size. The Ritleng probe facilitates the procedure.     

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.     

泪道激光术后留置泪道引流管与药物灌注治疗泪道阻塞的疗效对比观察

目的:比较泪道激光术后药物灌注与留置泪道引流管两种方法治疗阻塞性泪道疾病的临床效果。方法:将Nd:YAG激光疏通泪道,A组38例40眼,激光疏通泪道后联合新型泪道引流管留置3mo。B组45例49眼,激光疏通泪道后注入典必殊药膏。术后随访3～6mo,对比分析两组的治疗效果。结果:泪道激光疏通术后留置泪道引流管与药物灌注,两种方法均有明显效果。治愈33眼,治愈率82.5%,好转4眼,好转率10.0%,总有效率92.5%;B组:治愈21眼,治愈率42.9%,好转13眼,好转率26.5%,总有效率69.4%。经统计学分析两组间差异有显著性意义(χ2=7.291,P<0.05)。结论:泪道激光治疗泪道阻塞性疾病安全有效,联合留置新型泪道引流管治疗泪道阻塞方法疗效明显提高。     

YAG泪道激光治疗机联合典必殊眼膏填充治疗泪道阻塞

目的:观察YAG泪道激光治疗机联合典必殊眼膏治疗泪道阻塞的效果。方法:用特制9#空心泪道探针探查泪道至阻塞处,插入激光导光纤维,发射激光,术后注入典必殊眼膏。结果:对30例34眼随访观察1wk～6mo,经1次激光治疗,治愈34眼,其中1眼补2次激光,总治愈率为97%以上。结论:YAG泪道激光治疗机治疗泪道阻塞效果好,不插管,不住院,安全有效,费用低,术后联合药膏灌注泪道有利于巩固疗效,为常年流泪的患者,提供了新的治疗方法。     

Obstruction of the lacrimal drainage system

This review covers evolving concepts in lacrimal outflow obstruction. Recent studies have increased our understanding of the surgical anatomy and pathophysiology of the lacrimal drainage system through radiologic, clinical, and microbiologic techniques. While external dacryocystorhinostomy remains an important treatment for nasolacrimal duct obstruction, there have been a number of therapeutic developments worthy of review, including advances in endoscopic and transcanalicular dacryocystorhinostomy, conjunctivodacryocystorhinostomy, and the use of mitomycin C in these procedures. In addition, we summarize recent advances in minimally invasive techniques for lacrimal outflow obstruction, including balloon dacryocystoplasty, lacrimal stents, and conjunctivoplasty. Finally, the roles of probing versus irrigation, nasal endoscopy, and endoscopic dacryocystorhinostomy in children are discussed.     

Endonasal dacryocystorhinostomy using endoscopic guidance. Personal experience

INTRODUCTION: Endonasal dacryocystorhinostomy (DCR) with endoscopic guidance is one of the therapeutic answers for low obstructions of the lacrimal system and is of renewed interest thanks to modern optical and surgical endoscopic means. MATERIAL AND METHOD: Nine DCRs were performed on patients aged from 27 to 86 years, with a dual ENT-Ophthalmologist team, using transillumination of the lacrimal sac and the fitting of a two-canal probe for 3 months. RESULTS: Only the first case operated was a failure. The average success for lacrimal irrigation was 89% with a follow up of 3 to 15 months (average 8 months). In one case owing to a dacryolith, it was extracted with the endonasal approach. CONCLUSION: Peroperative transillumination of the lacrimal sac is the best guide to performing the stomy. The two-canal probe kept for 3 months in the neo-ostium perhaps ensures correct mucous healing. The technique is safe, efficient and not very traumatic: it should be a technique of first intention, capable of replacing the cutaneous approach.     

鼻泪管阻塞的治疗

泪囊鼻腔吻合术是治疗鼻泪管阻塞最常用、最经典的方法。近年来,随着内镜技术的发展和对泪液引流机制认识的深入,鼻泪管阻塞的治疗方法由经皮泪囊鼻腔吻合术发展为内镜泪囊鼻腔吻合术、泪道激光和置管、泪道内镜疏通术和泪道旁路手术等。内镜、激光和微创技术的应用,使鼻泪管阻塞的治疗手段多样,治疗成功率高、创伤小、复发率低、并发症少、恢复快。     

Iatrogenic complications related to the use of Herrick Lacrimal Plugs

PURPOSE: To report a series of lacrimal complications associated with a specific type of lacrimal plug (Herrick Lacrimal Plug; Lacrimedics Incorporated, Rialto, CA.) DESIGN: Retrospective, noncomparative case series and survey. METHODS: Members of the American Society of Ophthalmic Plastic and Reconstructive Surgery were asked to submit personally treated cases of patients referred for treatment of complications after placement of a Herrick Lacrimal Plug. MAIN OUTCOME MEASURES: Failure of the device to be removed by simple lacrimal irrigation. RESULTS: The clinical courses of 41 patients were analyzed. Patients ranged in age from 19 to 81 years, and all had symptomatic epiphora related to the presence of the lacrimal plug. Several interventions were used to treat lacrimal obstruction. Nasolacrimal duct probing with irrigation was used in 15 lacrimal systems, whereas six systems were probed and subsequently stented with silicone tubing. Eyelid margin cutdown was used in eight cases. Balloon dacryoplasty was performed in three systems, dacryocystorhinostomy in 18 instances, and conjunctivodacryocystorhinostomy in two patients. CONCLUSIONS: The Herrick lacrimal occlusion device sometimes cannot be removed by simple irrigation and is capable of inducing permanent, irreversible, symptomatic lacrimal drainage system obstruction.