放射核素动态显像评估结膜松弛对泪液排出的影响

Evaluation of effect of conjunctivochalasis on lacrimal drainage by using^(99mm) Tc-Single-photo emission computed tomography

目的 :评估结膜松弛症对泪液排泄系统的影响。方法 :结膜松弛症与对照组各 8例 (16只眼 ) ,在SPECT下 ,用99mmTcO-4 动态显像 ,比较结膜松弛症组与对照组T1/2值和结膜松弛症组手术前后的T1/2值。结果 :结膜松弛症组T1/2值(2 92± 198)明显大于对照组 (110± 38) ,差异有显著性意义 (t=3 5 8,P <0 0 1)。结膜松弛症组手术后T1/2值 (2 45± 115 )较手术前明显缩短 (35 6± 189) ,差异具有显著性意义 (t=3 18,P <0 0 1)。手术切除松弛结膜后解除了对泪液排泄系统的影响 ,患者的溢泪症状改善。结论 :结膜松弛症中泪液排泄系统功能不全 。

Objective:To investigate the effect of conjunctivochalasis on the lacrimal drainge.Methods:In 8 patients(16 eyes) with conjunctivochalasis,the redundant bulbar conjunctivae below the inferior limbus were excised for an elliptical area(3～6 mm×10～14 mm) under local anesthesia.Surgical wounds were closed with running 10-0 polypropylene sutures.Age-matched 8 patients(16 eyes without epiphora) were selected as control group. 99 mmTc-Single-photo emission computed tomography( 99 mmTc-SPECT) was used to compare the T1/2 values(median transit time) of patients and controls,and the preoperative and postoperative values in conjunctivochalasis group.Results:T1/2 values in patient group(292±198) was higher than that in control group (110±38).The difference was significant (t=3.58,P<0.01).As postoperative T1/2 value (356±189) was lower than the preoperative T1/2 value (245±115),the difference was also significant (t=3.18,P<0.01).Excision of the redundant conjunctiva removed the mechanical disruption of normal tear flow.Epiphora cured or improved in 15 eyes (93.75%).Slit lamp microscopic examination showed no relaxed conjunctiva in 14 eyes(87.5%).Conclusion:One of the causes of epiphora is relaxed bulbar conjunctiva,which protrudes over the lower eyelid margin,interfering the normal flow of tear to the lacrimal excretory part.Excision of the redundant bulbar conjunctiva may cure the epiphora.