Nd:YAG激光泪道成形术中应用妥布霉素地塞米松眼膏的疗效和安全性观察

Efficacy and Safety Observation of Tobramycin Dexamethasone Eye Ointment in Nd:YAG Laser Lacrimal Duct Plasty

目的:观察钇铝石榴石激光泪道成形术(Nd:YAG激光泪道成形术)中应用妥布霉素地塞米松眼膏的临床疗效及安全性。方法:选取我院2013年1月-2017年1月在Nd:YAG激光泪道成形术中应用妥布霉素地塞米松眼膏治疗的阻塞性泪道疾病患者1 000例(1 250眼)的病历资料,按泪道阻塞的部位分为慢性泪囊炎组(380眼)、泪小(总)管阻塞组(360眼)、鼻泪管阻塞组(342眼)、泪小点阻塞组(86眼)及外伤性泪小管离断组(82眼)。5组患眼术中将稍加热后的妥布霉素地塞米松眼膏装入1 m L注射器内通过探针注入泪道内,边推注边退出探针。术后定期冲洗泪道,随访3个月。对各组疗效及安全性进行比较。结果:慢性泪囊炎组患眼术后治愈率为85.00%、有效率为87.63%,泪小(总)管阻塞组患眼术后治愈率为87.78%、有效率为94.45%,鼻泪管阻塞组患眼术后治愈率为89.18%、有效率为95.03%,泪小点阻塞组患眼术后治愈率为84.88%、有效率为94.18%,均显著高于外伤性泪小管离断组患眼的治愈率(42.68%)、有效率(64.63%),差异均有统计学意义(P<0.05)。5组患眼不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:Nd:YAG激光泪道成形术在治疗慢性泪囊炎、泪小(总)管阻塞、鼻泪管阻塞、泪小点阻塞中应用妥布霉素地塞米松眼膏的疗效较好,且不良反应发生率较低。

OBJECTIVE： To observe clinical efficacy and safety of Tobramycin dexamethasone ointment in Nd： YAG laser lacrimal duct plasty. METHODS： Medical records of 1 000 patients （1 250 eyes） with obstructive lacrimal duct disease receiving To- bramycin dexamethasone ointment in Nd： YAG laser lacrimal duct plasty were selected from our hospital during Jan. 2013-Jan. 2017. They were divided into chronic dacryocystitis group （380 eyes）, small tears （total） tube obstruction group （360 eyes）, naso- lacrimal duct obstruction group （342 eyes）, punctal occlusion group （86 eyes） and traumatic canalicular laceration group （82 eyes） according to the lacrimal duct obstruction. In 5 groups, heated Tobramycin and dexamethasone ophthalmic ointment would be loaded in 1 mL syringe and injected into the lacrimal duct via probe, dropping the probe while pushing the ointment. They received lacrimal duct flushing regularly and were followed up for 3 months. Therapeutic efficacies and safty were compared among 5 groups. RESULTS： Cure rate and response rate of patients with chronic dacryocystitis were 85.00% and 87.63 %; those of patients with lacrimal small （total） obstruction were 87.78% and 94.45% ; those of patients with nasolacrimal duct obstruction were 89.18% and 95.03% ; those of patients with punctal occlusion were 84.88% and 94.18%. All of above were significantly higher than 42.68% and 64.63% of patients with traumatic canalicular laceration, with statistical significance （P〈0.05）. There was no sta- tistical significance in the incidence of ADR among 5 groups （P〉0.05）. CONCLUSIONS： In the treatment of chronic dacryocystitis, small tears （total） tube obstruction, nasolacrimal duct obstruction and punctal occlusion, application of Tobramycin dexamethasone eye ointment in Nd： YAG laser lacrimal duct plasty shows good therapeutic efficacy and has less ADR.