泪点成形联合泪小管阻芯置入术治疗泪点狭窄的临床观察

Efficacy of punctoplasty combined with lacrimal ductule blocking core implantation in the treatment of puncta stenosis

目的:探讨泪点成形术联合泪小管阻芯置入术治疗泪点狭窄的可行性及临床疗效。方法:选择2018-03/2019-07在本院进行诊治的由于泪点狭窄或者闭锁导致溢泪的患者56例88眼,使用小梁咬切器行下泪点成形术,然后置入硅胶泪小管阻芯,术后2wk取出阻芯,随诊3mo,通过术前术后溢泪评分、泪点形态分级、荧光素染色消失试验来评价该联合手术的疗效。结果:术后随访3mo,溢泪评分均低于术前,泪点形态较术前显著改观,荧光素染色消失试验明显改善。患者1例2眼取出阻芯后由于瘢痕增生,再次发生泪点闭锁。本组患者治愈率92%,好转6%,无效2%,总有效率98%。术中无明显并发症,术后轻微并发症率7%,未出现严重并发症。结论:泪点成形联合泪小管阻芯置入术治疗泪点狭窄是一种安全、有效的新方法,该手术安全,损伤小,操作简单,可以提高泪点成形手术效果。

AIM:To explore the feasibility and efficacy of punctoplasty combined with lacrimal ductule blocking core implantation in the treatment of puncta stenosis.METHODS:Fifty-six patients(88 eyes)who had epiphora due to puncta stenosis or atresia from March 2018 to July 2019 were enrolled in Jinan mingshui eye hospital.All patients underwent punctoplasty by using trabeculectomy punch combined with a lacrimal ductule blocking core.The core was removed at 2wk after operation.A follow-up of 3mo was taken for final analysis.The epiphora scores,the gradation of punctal morphology and fluorescein staining disappearance test were analyzed pre-and postoperatively.RESULTS:The epiphora scores 3mo after surgery was decreased compared with the preoperative ones.Both the punctal morphology and the fluorescein staining disappearance test were significantly improved 3mo after surgery.One patient had second puncta atresia due to scar hyperplasia after removing the core.The total effectiveness was 98%,of which 81 eyes(92%)were cured compeletely and 5 eyes(6%)were improved significantly.Only 2 eyes(2%)had no effect.No intraoperative complications were observed and minor complications rate was 7%.CONCLUSION:Punctoplasty combined with lacrimal ductule blocking core implantation is a safe and effective new method for the puncta stenosis,which is easy to perform and improve the effect of punctoplasty.