Preliminary study on the efficacy of lacrimal duct reconstruction with pedicled conjunctival flap in the treatment of severe lacrimal canalicular obstruction with conjunctivochalasis

AIM:To determine the efficacy and safety of pedicled conjunctival lacrimal duct reconstruction in the treatment of severe obstruction of superior and inferior lacrimal canaliculi with conjunctivochalasis.METHODS:This study was per formed as a retrospective analysis of patients who received conjunctival dacryocystorhinostomy with pedicled conjunctival flap reconstruction combined with tube intubation due to severe superior and inferior lacrimal canalicular obstruction with conjunctivochalasis from January 2019 to October 2019.The clinical data included the degree of preoperative epiphora and postoperative relief,preoperative examination of lacrimal duct computed tomography and ultrasound biomicroscopy,postoperative evaluation of lacrimal duct function by chloramphenicol taste and fluorescein dye disappearance test,etc.Syringing was carried out to determine the reconstruction and patency of the lacrimal duct.RESULTS:All 9 patients(9 eyes)had severe canalicular obstruction with conjunctivochalasis.The patients included 4 males and 5 females aged between 47–65y with an average age of 52.2±6.7y.At 3mo follow-up,the tube was removed and the patients were followed for a further 3mo.After tube removal,6 patients showed no epiphora.These patients also had positive chloramphenicol tastes and normal fluorescein dye disappearance test results.Two patientshad epiphora.Also,syringing showed partial patency of the reconstructed lacrimal duct.One patient had no improvement in epiphora with negative chloramphenicol taste and fluorescein dye disappearance test results and obstruction of the reconstructed lacrimal duct.The total effective rate of the operation was 8/9,with no serious complications.CONCLUSION:Pedicled conjunctival lacrimal duct reconstruction conjunctival dacryocystorhinostomy is safe and effective for superior and inferior canalicular obstruction with conjunctivochalasis.

Old canalicular laceration repair:a retrospective study of the curative effects and prognostic factors

AIM： To investigate the epidemiology and surgical outcomes of old canalicular laceration and analyze the variables impacting on the prognosis of reparation. METHODS： A retrospective review of all old canalicular laceration repairs from Jan. 1, 2008 to Dec. 30, 2015 was performed. Analyzed data included demographics, mechanisms of injury, the time from injury to repair, causes for delayed repair, old associated injuries, the types of surgery, and the effects of repair using canaliculus anastomosis combined with bicanalicular stent intubation. RESULTS： Totally 148 patients with old canalicular laceration received surgical repair and were enrolled. The mean age at presentation was 32.52 years old （ranged from 3 to 63 years old）. The 110 patients （74.32%） were male and 127 patients （85.81%） were adults （__.18 years old）. The old upper, lower, and bicanalicular lacerations were found in 5 （3.38%）, 39 （26.35%）, and 104 patients （70.27%）, respectively. The mechanism of old injury was primarily due to motor vehicle accidents （n=53, 35.81%）. The mean time from injury to repair was 43.61mo （ranged from 1 to 360mo）. Associated old ocular and orbit injuries were found in 65 patients （43.92%）, and chronic dacryocystitis in 18 patients （12.16%）. The main cause of delayed repair was that doctors or patients didn＇t pay attention to the canalicular laceration because of the concurrent severe injuries （n=71, 47.97%）. Totally 136 patients （91.89%） with old canalicular laceration underwent canaliculus anastomosis combined with bicanalicular stent intubation. In all of them, 20 patients （13.51%） were combined with dacryocystorhinostomy. In these cases, 132 patients （97.06%） attained anatomic success, 121 patients （88.97%）reported no epiphora （functional success）, 11 patients （8.09%） reported significant epiphora anesis （functional improvement）, and 4 （2.94%） reported no significant anesis （functional failure）. Rates of anatomic success and functional success were significantly correlated with different canaliculus involved. However, rates of anatomic success and functional success were not significantly affected by the time from injury to repair. CONCLUSION： The canalicular anastomosis combined with bicanalicular stent intubation could act as an effective therapeutics for old canalicular laceration.

One-stitch anastomosis through the skin with bicanalicular intubation:a modified approach for repair of bicanalicular laceration

AIM:To evaluate the efficacy and safety of one-stitch anastomosis through the skin with bicanalicular silicone tube intubation in repairing of bicanalicular laceration.METHODS:The clinical data of 15 consecutive patients with both superior and inferior canalicular laceration in one eye who underwent surgical repair using one-stitch anastomosis through the skin and bicanalicular stent were retrospective studied.All the operations were performed under surgical microscope,5-0 silk sutures were used and were with bicanalicular silicone tube(diameter was 8mm) intubation,for one lacerated canaliculi one-stitch anastomosis through the skin.The stents were left in place for 3 months postoperatively and then removed.The follow-up period was 3-36 months(average 14 months). RESULTS:In 15 patients,13 patients were cured entirely,1 patient was meliorated,1 patient with no effects.All patients had got good recovery of eyelid laceration with no traumatic deformity in eyelid and canthus.Complication was seen in one case,for not followed the doctor’s guidance to come back to hospital to had the suture removed on the 7thday after operation,when he came at the 15thday,the inferior canalicular wall and eyelid skin were corroded by the suture caused 2mm wound,and the inside silicone tube was exposed,a promptly repair with 10-0 nylon suture was done,the wound healed in a week.There were no early tube protrusions and punctal slits in the patients.CONCLUSION:One-stitch anastomosis through the skin with bicanalicular silicone tube intubation is a good method in repair of bicanalicular laceration in one eye,the cut ends can be anastomosed directly,and with excellent cosmetic results,it is acceptable for the patients.For there is no suture remained in the wound permanently,so there is no suture-related granuloma which may cause obstruction or stenosis of canaliculi.It is simple,economical,effective and safe.

Diagnosis of lacrimal canalicular diseases using ultrasound biomicroscopy: a preliminary study

· AIM: To evaluate the application of ultrasound biomicroscopy(UBM) in the examination of lacrimal canalicular diseases, and to investigate UBM image characteristics of lacrimal canaliculi in disease states.·METHODS: Sixty cases(63 eyes, 69 canaliculi) of lacrimal canalicular diseases were enrolled that included32 patients(32 eyes, 32 canaliculi) with chronic lacrimal canaliculitis, 18 patients(18 eyes, 18 canaliculi) with previous lacrimal canalicular laceration, 9 patients(12eyes, 18 canaliculi) with congenital absence of lacrimal puncta and canaliculi, and 1 case(1 eye, 1 canaliculus)of canalicular mass. The patients were examined using UBM, and disease-specific features of the UBM images were noted.· RESULTS: UBM imaging of lacrimal canaliculi in chronic canaliculitis patients showed obvious ectasia of the lacrimal canalicular lumen. Dot-like moderate echoic signals were detected on some ectatic lumina of the lacrimal canaliculus. Some lumen-like structures of the lower lacrimal canaliculus were observed in 2(2 eyes, 2canaliculi) of the 9 patients(12 eyes, 18 canaliculi) with congenital absence of the lacrimal canaliculus. Of the 18patients(18 eyes, 18 canaliculi) with previous lacrimal canalicular laceration, the lacerated end on the nasal side of the lacrimal canaliculus was detected only in 14patients(14 eyes, 14 canaliculi).·CONCLUSION: UBM can be used to evaluate lacrimal canalicular diseases and can provide an imaging basis for the diagnosis of lacrimal canalicular diseases.

Risk factors for persistent epiphora following successful canalicular laceration repair

AIM:To identify the risk factors of epiphora in patients with anatomical patency after surgical repair of canalicular laceration.METHODS:This retrospective case series included 178 cases of canalicular laceration repair from 2005 to 2012.Demographic data collected from each patient included age,sex,type of injury,distance from the distal lacerated end of the canaliculus to the punctum,the severity score for the structural abnormity of the medial canthus,the duration of stent placement,and the timing of surgery.The risk factors for epiphora were evaluated using Logistic regression models.RESULTS:Among the 178 cases,45(25.3%)with lacrimal patency after irrigation had symptomatic epiphora at the final follow-up.Patients'sex,age,type of injury,duration of stent placement,timing of surgery,and concurrent trauma were not found to be significantly associated with symptomatic epiphora after surgical repair of the lacerated canaliculus(P>0.05).A distance of more than 5 mm from the distal cut end to the punctum was closely and significantly associated with symptomatic epiphora after surgical repair of the lacerated canaliculus(P<0.01).Symptomatic epiphora was significantly more frequent in patients with higher severity scores for structural abnormities of the medial canthus(P<0.01).CONCLUSION:Our results indicate that the risk factors for postoperative symptomatic epiphora include a further distance between the distal cut end and the lacrimal punctum and a higher severity score for structural abnormities of the medial canthus.These findings could be used to prognosticate postoperative symptomatic epiphora.

Endoscopic transnasal canaliculorhinostomy for refractory common canalicular obstruction with an unidentifiable lacrimal sac

AIM:To describe the role of endoscopic transnasal canaliculorhinostomy(ETC)in refractory common canalicular obstruction(CCO)associated with an absent or unidentifiable lacrimal sac.METHODS:The records of patients with refractory CCO who underwent ETC at the Eye Hospital of Wenzhou Medical University from October 2007 to December 2016 were retrospectively reviewed.RESULTS:Fifty-six patients(56 eyes)with refractory CCO were recruited into the study.Eight patients were excluded due to the presence of a residual lacrimal sac or failure to complete the follow-up duration.The anatomic and functional success rates were both 85.4%(41/48)at a mean follow-up of 18.6 mo.Five cases failed as a result of ostial synechia and two failed because of ostial obstruction by granulation.Postoperative complications included mild nasal bleeding in 5 cases,dried nasal feeling in 8 cases,and olfactory dysfunction in 4 cases.CONCLUSION:Although being surgically challenging,ETC has comparable findings to its external approach counterpart or conjunctivodacryocystorhinostomy(CDCR)with Jones tube.And it may prove to be a novel alternate surgical technique for patients with refractory CCO without identifiable lacrimal sac.

Use of Silicone Tubes to Repair Canalicular Lacerations via a Novel Method

Purpose:To develop a novel method to repair canalicular lacerations using silicone tubes.Methods:A total of 47 adult patients(47 eyes)with canalicular lacerations were collected from the outpatient department from November 2010 to December 2012.The age ranged from16 to 53 years.Among the 47 eyes,37 had lower canalicular lacerations,6 had upper canalicular lacerations,and 4 had bicanalicular lacerations..A soft probe was made using a stainless steel acupuncture needle,which was inserted into the lumen of the proximal part of the catheter to increase its rigidity.The probe was then inserted into the lacrimal sac and nasolacrimal duct.After retrieval of the catheters,the two ends of the silicone tube were securely tied.(end to end).to the catheters..The silicon tube outside the nostril formed a Ushape.The catheters were then pulled upward until the silicone tube was completely located in the canalicular system.The catheters were cut off of the silicone tube near the site of the connection.The two ends of the silicone tube were cut short,~2mm out of the lacrimal punctum,and tied securely,end to end.The length of the tube between the upper and lower punctum was adjusted to ensure that no tension was present in the medial cathus,and the suture was removed through the nostril.The silicone tube was removed 3-10 months after this novel canalicular intubation procedure (NCI).Results:.All cases were anatomically rehabilitated after surgery..The silicone tube was removed after implanted in 3-10months (mean 4.5±1.3 months),the average follow-up time was 11.8 months after removal.In total,45 eyes in all 47eyes (95.74%)were free from obstruction.Among them,41eyes (91.11%) achieved complete success(completely disap-pearance of epiphora after tube removal),.4 eyes.(8.89%)achieved partial success.(irritation occurs under stimulation conditions,such as wind or cold conditions),4 eyes showed postoperative tearing,with three eyes having inferior lacrimal duct laceration,and one eye with superior canalicular laceration.Apart from two cases (4.26%) suffering inferior punctum splitting,no other associated issues occurred with the silicone tube or iatrogenic injury and lacrimal complications.Conclusion:For adult patients with canalicular laceration,the NCI was an effective,atraumatic surgery,which has fewer complications than traditional canalicular suture.

Therapeutic effects of two anastomoses of lacrimal passage on canalicular laceration

Objective： To evaluate the therapeutic effects of two anastomoses （canaliculus-to-lacrimal sac anastomosis and end-to-end anastomosis） on nasolacrimal laceration for over 7 mm from the broken end to the dacryon. Methods： A total of 71 patients （44 males and 27 females, aged 16-55 years, mean=34.32 years） with fresh canalicular laceration were treated in our hospital from March 2003 to April 2008. Under a microscope, 37 patients were treated with lacrimal sac anastomosis （the treatment group） and 34 with end-to-end anastomosis （the control group）, detaining silicone tubes till 3 months later. Results： The cure rate of the treatment group （89.19%） was significantly higher than that of the control group （55.56%）. Class I cure rates were 70.27% in the treatment group and 47.06 % in the control group, and the difference between the two groups was significant （P〈0.05）. Postoperative inflammatory reactions had significant influences on the two kinds of anastomosing methods, but no significant difference was found between the two groups （P〉0.05）. Conclusions： When the distance from the broken end to the dacryon is over 7 mm, especially when it is necessary to find the paranasal broken end of the lacrimal canaliculus with dacryocystotomy, canaliculus-to-lacrimal sac anastomosis is a better treatment method than end-to-end anastomosis for laceration of lacrimal canaliculus.

A clinical application of laser direction in anastomosis for inferior canalicular laceration

Objective： To study the therapeutic efficiency and effecacy of laser-directing approach on searching for the nasal broken end of lacerated lacrimal canaliculus in anastomosis for canalicular laceration. Methods ： Forty-nine patients （ 49 eyes ） suffering from traumatic inferior canalicular laceration were divided into control group and laser-directing group. The distance between the lacrimal puncture and the nasal broken end of lacerated lacrimal canaliculus was more than 6 ram. During the course of management of eyelid trauma, the patients were treated by canalicular anastomosis operation with traditional method and laser-directing method in searching for the nasal broken end of lacerated lacrimal canaliculus respectively. The silicone tube of 1 mm diameter was intubated in the lacrimal passage as a stent for 4 to 6 months. Results： In the laser-directing group, the mean time in searching for the nasal broken end of lacerated lacrimal canaliculus was （5.75 ± 1.49） minutes and the mean time of operation was （49.21 ±3.37） minutes; both were significantly shorter than that of the control group （P 〈 0.01 ）. The cure rate of the laser-directing group was 96.55 %, higher than that of the control group but without statistical significance （ P 〉 0.05 ）. Conclusions： The laser-directing method is much quicker and more convenient to searching for the nasal broken end of the lacerated lacrimal canaliculus than the traditional approach, and patients suffer less pain and damaging in canalicular anastomosis operation.

Efficiency and therapeutic effect of modified pigtail probe in anastomosing lacerated lacrimal canaliculus

Objective： To investigate the necessity of modification to the traditional pigtail probe and evaluate its efficiency and therapeutic effect in searching the nasal cut ends and anastomosing the lacerated lacrimal canaliculus. Methods： Eighty-seven patients （including 87 eyes） suffering from canalicular laceration were randomized into two groups： 41 patients treated with traditional pigtail probes （Group A） and 46 with modified pigtail probes （Group B）. During the reconstruction of the lacerated canaliculi, the traditional pigtail probe and the modified pigtail probe were used respectively to seek for the nasal cut ends of lacerated lacrimal canaliculi. Peripherally inserted central catheter （PICCTM） silicone tube with diameter of 0.95 mm was intubated as a stent for 4-6 months. The surgical outcomes were retrospectively analyzed after stent removal. Results： In Group B, the primary success rate of searching the nasal cut ends of lacerated lacrimal canaliculi was 93.48% （43/46） and the final success rate was 97.83% （45/46）. No false passage formed in Group B. Statistical sig- nificance was found between Group A and Group B as the primary success rates of searching the nasal cut ends （ x^2 = 10.522, P〈0.01） and the false passage forming rates were concerned （ x^2=4.704, P〈0.05）, whereas no significance was found between the two groups as the final success rates were concerned （ x^2=0.007, P〉0.05）. The mean time of searching the nasal cut ends of lacerated lacrimal canaliculi in Group B was （5.02±2.73） minutes and the mean time of operation was （33.90±4.84） minutes, and both were significantly shorter than those of Group A （t1=9.779, t2=10.700, P〈0.01）. The cure rate of Group B was 95.65%, though higher than that of Group A, no statistical significance was found （Z=-1.007, P〉0.05）. Totally, 2 patients （2.30%） were found to be absent of common canaliculus and underwent bicanalicular nasal intubation in the two groups. Conclusions： Pigtail probes are efficient and convenient apparatus for searching the nasal cut ends of the lacerated lacrimal canaliculi in the reconstruction of canalicular laceration. Necessary or proper modifications to the pigtail probes can minimize the risk of iatrogenic damages or complications and enhance the efficiency and therapeutic effect of canalicular repair.

RS泪道再通硅胶软管体留置支撑物在泪小管断裂吻合术中的应用

目的:探讨RS泪道再通硅胶软管在泪小管断裂吻合术后留置作支撑物的临床效果。方法:选取2017年1月-2020年12月笔者科室收治的223例泪小管断裂患者作为研究对象,均予以RS泪道再通硅胶软管作为支撑物行泪小管断裂吻合术,于显微镜直视下寻找鼻侧泪小管断端,将RS泪道再通硅胶软管置入上下泪小管,采用8-0可吸收缝线间断缝合断端3针,术后10 d拆线,RS泪道再通硅胶软管留置3个月后取出,术后随访1年。观察术中泪小管断裂吻合情况,术后3个月临床疗效及随访期间并发症发生情况。结果:术中泪小管断裂100.00%吻合。术后3个月,治愈215例(96.41%),好转8例(3.59%),无效0例(0.00%)。随访期间,出现泪小点及泪小管部分撕裂3例,下睑轻度外翻,导致术后轻度流泪2例,泪小管断端瘢痕2例,泪小点增生及息肉1例,并发症发生率为3.59%。结论:泪小管断裂吻合术中应用RS泪道再通硅胶软管作支撑物手术治疗效果较佳,术后并发症较少,安全性较高。

泪囊鼻腔吻合加泪小管置管治疗创伤性泪道损伤

目的探讨泪囊鼻腔开放加泪小管置管对创伤性泪道损伤的治疗作用。方法选择2010年2月至2020年10月在佛山市中医院手术的62例面中部骨折合并泪道损伤患者进行分析、回顾,病程超过4周的患者的治疗过程,所有患者均行泪道造影,28例患者行下鼻道逆行鼻泪管义置管术,34例患者行鼻内镜下经鼻泪囊鼻腔吻合+泪小管置管术,术后随诊18个月以上,观察术后疗效。结果经下鼻道鼻泪管义管置管组,治愈12例,有效8例,无效8例,有效率为71.43%(20/28);鼻内镜下经鼻泪囊鼻腔吻合+泪小管置管组,治愈23例,有效9例,无效2例,有效率为94.12%(32/34),泪囊鼻腔吻合+泪小管置管组高于鼻泪管义管置管组,差异有统计学意义(P<0.05)。其中有15例患者因泪囊鼻泪管受压无法行经下鼻道鼻泪管义管置管,只能内镜下经鼻去除骨折片行泪囊鼻腔吻合术(加置管)。结论经下鼻道鼻泪管义管植入,手术简单,耗时较少,对于病程超过4周的创伤性泪道损伤患者,仍然具有一定的治疗作用,但有时骨折移位时无法成功经下鼻道植入义管,经鼻泪囊鼻腔吻合+泪小管置管的有效率更高,值得临床推广使用。

儿童泪小管断裂34例临床分析

目的探讨儿童泪小管断裂的临床特点及手术治疗效果。方法回顾性分析郑州市第二人民医院2016年8月至2022年8月诊治的儿童泪小管断裂患者34例(34眼),均在全麻显微镜下行Ⅰ期泪小管断裂吻合术,术中植入RS-1型泪道引流管。术后2~6月后拔管,随访6月,对其临床特点、手术疗效及并发症进行分析总结。结果34例患者,男性24例,平均年龄(4.79±2.45)岁,下泪小管断裂最多见(23例),致伤原因多为意外摔伤(15例);手术均成功完成,拔管后,治愈31例(91.2%),好转2例(5.9%),无效1例(2.9%),总有效率97.1%;术后泪道引流管移位1例,泪小点轻度撕裂1例,泪小点轻度外翻1例,所有患者均未见明显眼睑瘢痕及畸形。结论全麻显微镜下行Ⅰ期泪小管断裂吻合术联合RS-1型泪道引流管植入操作简便,手术成功率高,并发症少,是治疗儿童泪小管断裂的有效可靠的手术方法。

Worst泪道探针联合改良泪道穿线插管法在复杂性泪小管断裂吻合术中的应用

目的:探讨Worst泪道探针联合改良泪道穿线插管法在复杂性泪小管断裂吻合术中的应用价值。方法:回顾性研究。选取2019-03-01/2021-03-31遵义医科大学第二附属医院眼科收治的复杂性外伤性泪小管断裂患者68例68眼。根据手术方式分为两组,A组患者36例36眼采用Worst泪道探针寻找泪小管断端并联合改良泪道穿线插管法治疗,B组患者32例32眼采用显微镜下寻找泪小管断端,双路插管法吻合泪小管术治疗。比较两组患者临床疗效、术中寻找泪小管断端成功率、寻找泪小管断端时间、手术时间、疼痛程度、术后眼部异物感及并发症情况。结果:A组患者临床疗效总有效率高于B组(94%vs 38%),术中寻找泪小管断端成功率高于B组(100%vs 47%),寻找泪小管断端时间、手术时间均短于B组,疼痛程度评分低于B组(均P<0.05)。术后随访6mo~1a,A组患者术后眼部异物感评分、泪小点撕裂及形态变化发生率、溢泪程度均低于B组(均P<0.05)。结论:Worst泪道探针联合改良泪道穿线插管法治疗复杂性外伤性泪小管断裂能更精确找到泪小管断端,缩短手术时间,减轻患者疼痛及术后眼部异物感,提高临床疗效,降低并发症发生率。

泪小管塞栓治疗重度慢性眼移植物抗宿主病的安全性和有效性

目的:评估泪小管塞栓治疗重度慢性眼移植物抗宿主病(coGVHD)的安全性和有效性。方法:回顾性研究。纳入2022-06/09就诊于徐州医科大学附属医院干眼门诊的重度coGVHD患者9例,均行双眼下泪小管塞栓术。观察术前、术后1、3mo眼表疾病指数(OSDI)评分、泪河高度(TMH)、角膜荧光素染色评分(CFS)、结膜丽丝胺绿染色评分(CLGS)、非接触式泪膜破裂时间(NIBUT)、SchirmerⅠ试验(SⅠt)和使用共聚焦角膜显微镜检测角膜浅基质层浸润的朗格汉斯细胞密度,记录并发症发生情况。结果:术后3mo,患者OSDI评分为21.89±6.07分,较术前(67.33±12.64分)下降(P<0.01);TMH术后3mo为0.21±0.03mm较术前0.09±0.02mm上升(P<0.05);NIBUT术后3mo为6.77±2.05s较术前2.24±0.68s上升(P<0.01)。CFS和CLGS术后3mo为2.22±0.67、2.56±0.88分较术前(9.11±1.45、6.33±1.00分)下降(均P<0.01)。朗格汉斯细胞密度术后3mo为39.67±9.75cells/mm~2较术前140.22±38.18cells/mm~2下降(P<0.01)。SⅠt手术前后无差异(F=0.059,P=0.943)。随访期间未观察到栓子脱落等并发症发生。结论:泪小管塞栓治疗重度coGVHD安全有效,可显著改善干眼患者症状体征,减轻炎症反应。

泪小管断裂修复手术效果的影响因素

目的:分析比较泪小管断裂的部位、受伤类型对泪小管吻合手术效果的影响。方法:回顾性分析2016-01/2017-08收治的外伤性泪小管断裂患者87例87眼,均行泪小管断裂吻合术,术中置入硅胶泪道引流管,记录术后第3、6mo时泪道冲洗结果评估手术效果,术后3mo拔除引流管。统计致伤类型、远端距和泪道冲洗成功率,分析致伤类型和远端距与成功率的关系。结果:泪小管断裂患者中,近端组29眼(33%),中间组41眼(47%),远端组17眼(20%)。切割伤致泪小管断裂22眼(25%),其中泪小管断裂位于近端组18眼、中间组2眼、远端组2眼;钝器击打伤或撞伤致泪小管断裂65眼(75%),其中损伤位于近端组11眼、中间组39眼、远端组15眼。术后6mo,72眼泪道冲洗通畅,其中近端组20眼,中间组36眼,远端组16眼,三组术后解剖复位成功率分别是69%、88%、94%(P=0.047);切割伤和钝击伤泪道冲洗通畅患者分别为19眼和53眼,解剖复位成功率分别是86%、82%(P=0.605)。结论:切割伤易造成靠近泪小点的泪小管断裂,钝击伤易造成靠近泪囊或位于泪囊与泪小点中间部位的泪小管断裂。损伤位置靠近泪总管或泪囊的患者术后成功率较高,而钝击伤致近泪小点的泪小管断裂术后较易发生泪道狭窄或阻塞。

泪小管吻合术中植入泪道义管的临床分析

目的:探讨泪道义管的插管方法及种类对泪小管吻合术疗效的影响。方法:泪小管吻合术中采用直接插管和逆行插管在泪道内植入硬膜外导管、输尿管导管或硅胶管,治疗泪小管断裂87例,随访2～18mo。结果:直接插管组51例,治愈37例(使用硬膜外导管33例,治愈24例;输尿管导管18例,治愈13例);逆行插管组36例,治愈26例。各组治愈率比较,差异均无显著性(P<0.05)。结论:泪小管吻合术中采用直接插管或逆行插管的方法,在泪道内植入硬膜外导管、输尿管导管或硅胶管的疗效相当,都是治疗泪小管断裂的有效方法。

新型硅胶管治疗泪小管断裂的临床疗效(英文)

目的:评价新型硅胶管(RS一次性使用泪道引流管)治疗泪小管断裂的临床效果。方法:回顾性研究。收集2013-01/2015-10来我院就诊的47例47眼泪小管断裂患者完整的临床资料。在泪小管断裂吻合术中,新型硅胶管从上、下泪小点"U"形置入,在泪道中保留3mo。拔管后,观察泪道通畅率、是否伴有泪溢和其他并发症发生情况。结果:所有患者,泪小管吻合成功,新型硅胶管顺利植入。未发生硅胶管相关的并发症,如眼部刺激、泪小点外翻和撕裂、过早脱落等。治愈41例(87%),泪道冲洗通畅,无泪溢。部分治愈4例(9%),患眼轻微泪溢,但泪道冲洗通畅。失败2例(4%),患眼泪溢,泪道冲洗不畅。结论:在泪小管断裂吻合术中,新型硅胶管是一种安全、有效、无创的置入物,其操作过程简单,易于掌握,术者学习曲线短。

显微吻合术治疗外伤性下泪小管断裂56例

目的:探讨下泪小管断裂显微吻合术的疗效。方法:在显微镜下寻找断裂的下泪小管鼻侧断端,以硬膜外导管作为支撑吻合泪小管断端。结果:共56例(56眼)在显微镜下全部吻合,51例成功,5例好转。结论:该手术操作简单,成功率高,临床效果好,值得广泛推广。

泪小管断裂的3种吻合方法临床分析

目的:探讨不同情况下外伤性泪小管断裂吻合的简单有效方法。方法:回顾性分析住院治疗的73例外伤性泪小管断裂患者资料,归纳其手术方法和临床特点,并且随访。手术方法分别采用直接寻找法,弯针法,泪囊切开法。结果:经治疗73例患者中直接寻找法吻合56例,弯针法吻合15例,泪囊切开法吻合2例。泪小管断裂吻合治愈63例,好转9例,未愈1例。结论:大多数新鲜泪小管断裂可以直接找到鼻侧断端,少数可以用弯针法找到,个别解剖异常患者或陈旧性泪小管断裂患者需用泪囊切开法。