A comparison between monocanalicular and pushed monocanalicular silicone intubation in the treatment of congenital nasolacrimal duct obstruction

AIM: To compare the success rate of monocanalicular versus pushed monocanalicular silicone intubation(PMCI)of the nasolacrimal duct for congenital nasolacrimal duct obstruction(CNLDO).METHODS: In a prospective randomized clinical trial 53 eyes of 49 patients with CNLDO underwent either monocanalicular silicone intubation(MCI)(n =28 eyes) or PMCI(n =25 eyes). All procedures were performed by 1oculoplastic surgeon. Treatment success was defined as the complete resolution of epiphora at 3mo after tube removal.RESULTS: The surgical outcome was assessed in 20 eyes with MCI and 20 eyes with PMCI. The mean age of treatment was 26.25 ±10.08mo(range, 13-49mo) for MCI and 26.85±12.25mo(range, 16-68mo) for PMCI. Treatment success was achieved in 18 of 20 eyes(90.0%) in the MCI group compared with 10 of 20 eyes(50%) in the PMCI group(P =0.01). In the PMCI group, the tube loss(30%)was greater than the MCI group(5%), however the differences between the 2 groups proved to be not significant(P =0.91).CONCLUSION: Our results indicate that MCI has higher success rate in CNLDO treatment compared with PMCI in this small series of patients.

Effect of mitomycin combined with Nd-YAG laser on cell proliferation and invasion as well as MEK/ERK signaling pathway in obstructive lacrimal duct model

Objective: To study the effect of mitomycin (MMC) combined with Nd-YAG laser on cell proliferation and invasion as well as MEK/ERK signaling pathway in obstructive lacrimal duct model. Methods: New Zealand rabbits were selected as experimental animals and divided into model group, laser group and MMC + laser group;obstructive lacrimal duct model was established, then laser group were given Nd-YAG laser intervention, and MMC + laser group were given Nd-YAG laser combined with mitomycin intervention. 2 months after intervention, the expression of proliferation molecules, invasion molecules and MEK-ERK signaling molecules in lacrimal duct tissue were measured. Results: TGF-β, CTGF, PCNA, Ki-67, Col-I, Col-III, MEK, ERK1/2, MMP2 and MMP9 protein levels in lacrimal duct tissue of laser group were significantly higher than those of model group while TSG-6, Cthrc1 and TIMP1 protein levels were significantly lower than those of model group;TGF-β, CTGF, PCNA, Ki-67, Col-I, Col-III, MEK, ERK1/2, MMP2 and MMP9 protein levels in lacrimal duct tissue of MMC + laser group were significantly lower than those of laser group while TSG-6, Cthrc1 and TIMP1 protein levels were significantly higher than those of laser group. Conclusion:Mitomycin can inhibit cell proliferation and invasion as well as MEK/ERK signaling pathway activation in obstructive lacrimal duct model after Nd-YAG laser treatment.

Long-term outcomes of laser dacryoplasty combined with intubation using a new silicon tube in patients with lacrimal duct obstruction

AIM:To determine the 15-year outcomes of laser dacryoplasty(LDP)in patients with lacrimal duct obstruction;and to evaluate LDP combined with intubation using a new silicone tube to treat complicated cases.METHODS:Patients with lacrimal duct obstruction and treated with LDP between April 2000 and April 2005 were investigated retrospectively.Totally 116 eyes with completed 15-year follow-up records were included in this study.For complicated cases(52 eyes of 52 patients),both LDP and intubation using a self-made silicon tube were performed.For patients with uncomplicated obstruction(64 eyes of 61 patients),only LDP was performed.Outcomes were assessed based on results of lacrimal irrigation and degree of symptoms during follow-up.RESULTS:At the follow-up time of 15y,81 eyes achieved full success(69.8%);21 eyes got improved(18.1%);and 14 eyes were considered failure(12.1%).The success rate was 71.2%(37/52 eyes)for complicated cases;and 68.8%(44/64 eyes)for uncomplicated cases.No statistically significant difference between two groups was observed(P=0.961).No postoperative complication was observed.CONCLUSION:LDP is a well-tolerated,simple,and effective procedure with satisfactory long-term outcomes in selected patients,which make it a good alternative to conventional dacryocystorhinostomy.In addition,intubation with the self-made mono-canalicular silicone tube facilitates the management of complicated cases with few complications.

Pathological,immunohistochemical and microbiologicalal analysis of lacrimal sac biopsies in patients with chronic dacrocystitis

AIM:To analyze cases of obstruction of the nasolacrimal duct which creates a fertile environment for secondary bacterial Infection and can result in dacryocystitis,which is a constant threat to cornea and orbital soft tissue and a potential source of endophthalmitis following intraocular surgery.The majority of obstructions of the lacrimal excretory outflow system are acquired ones occurring in adulthood and involving the distal parts of the system.Acquired obstruction may be primary/idiopathic or secondary to a wide variety of infectious,inflammatory,traumatic,mechanical,toxic or neoplastic causes mimicking idiopathic inflammation.These cases are treated by dacryocystorhinostomy(DCR).METHODS:The present study was conducted to determine the histopathologic,immunohistochemical and current microbiologic characteristics of lacrimal sac specimens in patients undergoing external dacryocystorhinostomy.RESULTS:Non-specific lacrimal sac pathology was present in all 33 cases and 81.8%of the cases showed moderate chronic inflammation with a chronic inflammatory score(CIS)ranging between 4 and 6,whereas 12.12%showed severe inflammatory changes with a CIS of 7.Mild degree of inflammation was seen in6.06%with a CIS of 3.The total prevalence of grampositive,gram-negative,and culture-negative samples were 59.4%,37.5%,and 3%respectively.CONCLUSION:Non-specific chronic inflammation withfibrosis is indeed the most commonly reported histopathological finding in lacrimal sac wall biopsy specimens.

Computed tomography imaging features for amyloid dacryolith in the nasolacrimal excretory system:A case report

BACKGROUND Nasolacrimal duct obstruction leading to epiphora is a common ophthalmologic complaint,and it may derive from amyloidosis in rare cases.There are a few reports about localized amyloidosis,and amyloidosis with involvement and obstruction of the nasolacrimal duct is exceedingly rare.CASE SUMMARY A 54-year-old male presented with a 2-year history of a lump overlying the left lacrimal sac that had grown rapidly for nearly half a year.Physical examination touched a firm lump in the left lacrimal sac.Nasal endoscopy discovered lesions in appearance of sediments with easy bleeding at the entry of the nasolacrimal duct of the left inferior nasal meatus.Computerized tomography scan revealed speckle high density in the left lacrimal sac and the dilated nasolacrimal duct.During an endoscopic exploration and excision,a large number of dacryoliths were exposed.Pathology indicated amorphous pink material and multinucleated giant cell reaction in the fibrous tissue.CONCLUSION This case showed amyloidosis in localized form mimicking dacryolith with nasolacrimal duct obstruction.In clinical practice,we should be aware of the possibility of localized amyloidosis in the nasolacrimal excretory system.

Anatomic characteristics of the lacrimal sac and adjacent bony structures–a computed tomographicdacryocystography research

AIM:To describe the anatomic characteristics of the lacrimal sac and its adjacent bone structures and to provide surgical recommendations for endoscopic dacryocystorhinostomy(EN-DCR).METHODS:This retrospective comparative study involved 118 sides with complete nasolacrimal duct obstruction and 83 unaffected sides from 126 patients.Computed tomographic-dacryocystography(CT-DCG)scans were performed before lacrimal surgery,and image reconstruction was used to obtain continuous 0.75-mm axial,coronal,and segmental sections for review.The morphology of the lacrimal sac and its relationship with adjacent bony structures were determined for measurement,as well as the obstructed location.RESULTS:The height of the lacrimal sac was 12.99±2.10 mm in this study.The operculum of the middle turbinate(OMT)was located vertically in the lower third of the lacrimal sac.Horizontally,the junction between the maxillary bone and the lacrimal bone(MB-LB)was close to,mostly(60.2%)posterior to,the lacrimal sac.The uncinate process was more frequently attached to the lacrimal bones(75.1%).The obstructions were generally located around the entrance of the nasolacrimal duct(NLD).However,some were placed higher,with 7.63%blocked not lower than the OMT.There was a negative correlation between the diameter of the lacrimal sac and the level of obstruction(r=-0.35,P<0.01).CONCLUSION:In this study,the OMT and MB-LB can be served as the landmarks in EN-DCR.Partial uncinectomy should be performed in most cases.The obstructions were generally located around the entrance of the NLD,but some extreme individual variations strongly implies the importance of CT-DCG scanning before surgery.

基于骨性鼻泪管走向的逆行充气泪道CT造影三平面重组技术的初步研究

目的基于骨性鼻泪管走向的逆行充气泪道电子计算机断层扫描(CT)造影三平面重组技术,评估其检查泪囊前泪道阻塞患者的鼻泪管和泪囊通畅情况的准确性和安全性。方法纳入2022年10月—2023年12月的泪囊前泪道阻塞患者43例(57只眼),行充气前CT横轴位扫描,判断鼻泪管和泪囊空气存留情况。对充气前CT横轴位扫描鼻泪管和泪囊未充满空气的患者,使用自行设计制作的经鼻泪管下口逆行充气和气压监测系统使患者泪道充填空气,行CT横轴位扫描,并记录拍摄过程中最大鼓气气压值。对泪道CT横轴位扫描结果进行三维重建和以骨性鼻泪管走向的横轴位、冠状位和矢状位三平面重组分析其通畅情况,再与手术中探查结果对比,评估其准确性。同时观察并发症和不良反应,评估其安全性。结果(1)一般情况:逆行充气前,43例(57只眼)泪道阻塞患者中,泪囊及鼻泪管均充满空气有3例(4只眼),而空气未充满有40例(53只眼)。(2)逆行充气试验:逆行充气后,未完全充满空气的53只眼,鼻泪管和泪囊被气体均充满的33只眼,未见气体填充20只眼。术中验证33只眼的鼻泪管和泪囊均通畅,而20只眼中12只眼为鼻泪管下段真性阻塞,而8只眼鼻泪管无阻塞,该检查方法的灵敏度为80.4%,特异度为100.0%,准确率为84.9%。鼻腔鼓气的最佳气压值的参考范围为8~9 kPa。(3)并发症和不良反应:检查过程中及检查后均未见任何并发症和不良反应。结论基于骨性鼻泪管走向的逆行充气泪道CT造影三平面重组技术可以全程清晰显示双侧鼻泪管,有助于对于前泪囊阻塞患者的鼻泪管和泪囊通畅情况进行判断,安全性好,对临床治疗术式的选择有一定的指导意义。

鼻内镜下泪囊鼻腔造口术与泪道逆行置管术治疗鼻泪管阻塞的临床对比研究

目的 对比鼻内镜下泪囊鼻腔造口术与泪道逆行置管术治疗鼻泪管阻塞(NLDO)的临床效果。方法 50例鼻泪管阻塞患者,按就诊天数的单双号分为A组(单号日期, 25例)、B组(双号日期,25例)。A组实施鼻内镜下泪道逆行置管术, B组实施鼻内镜下泪囊鼻腔造口术。对比两组手术相关指标、并发症发生率、复发率。结果 A组手术时间(29.25±3.18)min、在院时间(0.85±0.23)d明显短于B组的(51.74±3.26)min、(4.47±1.26)d,出血量(5.03±1.06)ml少于B组的(46.45±11.12)ml(P<0.05)。A组并发症发生率(4.00%)低于B组(24.00%),但术后1年复发率(28.00%)高于B组(4.00%)(P<0.05)。结论 鼻内镜下泪道逆行置管术治疗鼻泪管阻塞较泪囊鼻腔造口术具有手术时间短、操作较容易、出血量少等优势,而鼻内镜下泪囊鼻腔造口术较泪道逆行置管术则更有利于预防术后复发。

Nd:YAG泪道激光联合泪道引流管置入对泪道阻塞患者疗效及并发症的影响

目的:探讨Nd:YAG泪道激光联合泪道引流管置入对泪道阻塞患者疗效及并发症的影响。方法:选取2018年2月—2023年2月海安市中医院收治的102例泪道阻塞患者作为研究对象,采用随机数字表法分为对照组与观察组,各51例。对照组采用传统泪道重建手术治疗,观察组采用Nd:YAG泪道激光联合泪道引流管置入治疗,比较两组治疗总有效率、并发症发生率及眼表状态。结果:术后1个月,观察组治疗总效率显著高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率显著低于对照组,差异有统计学意义(P<0.05)。两组术前及术后2个月的泪液分泌量、泪膜破裂时间比较,差异均无统计学意义(P>0.05)。结论:对泪道阻塞患者行Nd:YAG泪道激光联合泪道引流管置入治疗,能够显著提高患者的治疗有效率,降低并发症的发生率,并且不影响眼表状态。

鼻泪管支架植入术改善预后的研究进展

原发性鼻泪管阻塞通常表现为顽固性泪溢,可继发角膜炎、急慢性泪囊炎等影响眼部健康。鼻泪管支架植入为治疗该疾病的重要辅助方式,有效降低泪道探通、激光泪道成形、泪囊鼻腔吻合等术后膜性泪道再阻塞率。但术中机械损伤、术后持续的慢性炎症及瘢痕组织增生等问题仍会引起术后鼻泪管狭窄及再阻塞。文章就鼻泪管支架植入术再发性阻塞的发病机制及相应改善措施的前沿进展进行综述,为临床诊疗提供新思路。

单眼内窥镜下鼻腔泪囊吻合术后双眼眼表指标的变化

目的:探讨单眼内窥镜下鼻腔泪囊吻合术对双眼眼表指标的影响。方法:纳入于2022-12-01/2023-07-31诊断为单眼原发性获得性鼻泪管阻塞(PANDO),并成功实施内窥镜下鼻腔泪囊吻合术的患者45例。收集术前,术后0.5、1、3 mo的眼表指标,包括平均非侵入性泪膜破裂时间(NIBUT)、干燥综合征国际合作临床联盟眼部染色评分(SICCA OSS)、眼睑刷Korb评分、非表面麻醉泪液分泌试验(Schirmer test)。对比手术前后术眼与健眼在各个时间点上的各项指标。结果:术眼和健眼NIBUT、SICCA OSS、Korb评分、Schirmer test无明显的组间差异(均P>0.05)。术眼术后0.5、1、3 mo的Korb评分明显低于术前(P=0.034、0.044、0.027)。术眼术后1 mo的Schirmer test明显低于手术前(P=0.0461)。结论:内窥镜下鼻腔泪囊吻合术后泪液引流恢复正常,眼表损伤加重,这些变化通常在术后约1 mo达到峰值,然后逐渐恢复。

激光泪道成形联合置管治疗原发性获得性鼻泪管阻塞疗效的Meta分析

目的探讨激光泪道成形术联合泪道置管治疗原发性获得性鼻泪管阻塞(PANDO)的效果。方法检索中国知网、维普中文科技期刊全文数据库、万方数据库、中国生物医学文献数据库、PubMed、Cochrane Library、Embase等数据库,检索时限均为建库至2022年10月13日。建立纳入和排除标准,纳入符合标准的相关研究。提取数据,采用State 15.0软件分析手术的治愈率(有效或有效+治愈)。结果本Meta分析纳入22篇文献,涉及1299例鼻泪管阻塞患者。Meta分析结果显示,激光泪道成形术联合泪道置管治疗PANDO有效率为93%(ES=0.93,95%CI 0.88~0.96),激光泪道成形术联合泪道置管是治疗PANDO的有效手术方法。结论激光泪道成形术联合泪道置管治疗能明显改善PANDO的临床症状,是一种有效的治疗方法。

哺乳期乳腺脓肿临床特点及延误诊断原因分析

目的探讨哺乳期乳腺脓肿的临床特点及误诊原因,并总结防范误诊措施。方法回顾分析2023年1—6月收治的被误诊为乳管堵塞或积乳囊肿的哺乳期乳腺脓肿10例的临床资料。结果本组10例均以哺乳期乳房发现肿块伴疼痛为主要症状就诊,乳房无表面皮肤红肿及波动感,误诊为乳管堵塞7例,积乳囊肿3例,保守治疗2~5 d无效,后经彩色多普勒超声引导穿刺诊断为乳腺脓肿。10例行1~4次彩色多普勒超声引导下脓肿穿刺冲洗引流术等治疗,7例治愈,2例进一步行全身麻醉下置管引流,1例行小切口置管引流。10例皆治疗过程顺利,预后良好。结论临床上对于哺乳期短时间出现乳房肿块患者不能单纯通过红、肿、热、痛及波动感来评判是否为脓肿,需要通过彩色多普勒超声检查,结合患者发病时间和症状、体征综合分析,对于彩色多普勒超声检查提示的异常声像区域,避免热敷和按摩等刺激,必要时行诊断性穿刺,以明确诊断。

基于术前磁共振成像分类指导精囊镜技术治疗精道远端疾病的临床研究

目的探讨术前磁共振成像(MRI)分类指导精囊镜技术治疗精道远端疾病的可行性和安全性。方法回顾性分析2019年1月至2023年2月在合肥市第二人民医院接受精囊镜技术治疗的35例精道远端疾病患者的临床资料。所有患者术前均接受了精道远端的MRI检查,根据MRI影像学结果分为梗阻型精道远端疾病与非梗阻精道远端疾病两种类型。所有患者在硬膜外麻醉或全麻下接受F6/7.5精囊镜检查,分析并对比两种类型患者精囊镜手术的进镜成功率、进镜方式、手术时间、术后并发症等。结果35例精囊镜手术精囊镜均成功进入精囊。17例MRI诊断为梗阻型精道远端疾病的患者中,有88.2%(15/17)的患者术中需经小囊途径进入精囊,平均手术时间为(96.8±58.7)min;18例MRI诊断为非梗阻型精道远端疾病的患者中,有44.4%(8/18)的患者需经小囊途径进入精囊,平均手术时间为(96.9±59.2)min。两类患者进镜方式比较,差异具有统计学意义(P<0.05);但手术时间比较,差异无统计学意义(P>0.05)。经术后随访,所有患者均未出现附睾炎、逆行射精、直肠损伤等严重并发症。结论术前通过MRI影像对精道远端疾病患者进行分类可以有效指导精囊镜手术方式的选择,提高手术进镜的成功率,提高手术的安全性。

泪道置管术治疗泪道狭窄或阻塞的临床效果

目的研究对泪道狭窄或阻塞患者实施泪道置管术治疗的效果。方法选取2022年1月—2022年12月本院收治的50例泪道狭窄或阻塞患者为研究对象,均给予泪道置管术治疗,对比治疗前后眼表症状和治疗效果。结果治疗后眼表症状评分显著低于治疗前(P<0.05)。治疗后OSDI、SF-36评分显著优于治疗前(P<0.05)。经过统计,治疗有效率达到96.00%,术后出现并发症共计10例(20.00%),均采取对应处理措施进行治疗。结论针对泪道狭窄或阻塞,采取泪道置管术可有效改善症状,取得良好的治疗效果,提高患者生活质量。术后,患者可能出现不同程度的并发症,经过处理治疗后均恢复健康。

硅胶泪道引流管治疗泪道阻塞性疾病的临床观察

目的:探讨运用硅胶泪道引流管逆行泪道插管术治疗泪道阻塞性疾病的手术效果。方法:对68例83眼鼻泪管阻塞患者选用球头型硅胶管逆行插管术,对26例37眼泪小管或泪总管阻塞患者选用引线型硅胶管逆行插管术。结果:术后随访6～12mo,球头型硅胶管治疗组有效率87%,引线型硅胶管治疗组有效率73%。结论:逆行泪道插入硅胶泪道引流管治疗泪道阻塞性疾病,办法简便,效果良好,适合基层医院临床推广。

支架置入术治疗鼻泪管阻塞的长期疗效

目的 探讨鼻泪管阻塞聚氨酯支架置入术治疗方法的安全性及可行性 ,并评价其长期疗效。方法 对 5 3例 (6 4只眼 )鼻泪管阻塞患者行聚氨酯支架置入术 ,术前及术后行泪道造影检查。术后平均随访 4 8.3个月 (13～ 78个月 ) ,观察支架长期放置及取出后鼻泪管的通畅情况。结果 6 4只眼中 ,6 2只眼成功置入支架 ,技术成功率 96 .9% ,未发生严重并发症。术后 1年随访 ,支架通畅率为 76 .8% ,3及 5年时分别降至 33.3%和 2 8.6 %。 9枚完全阻塞的支架被取出 ,其中 4枚发现有增生的组织 ,5枚有黏液样物质 ,2侧鼻泪管在支架取出后造影通畅 ,另 2侧再次置入支架后通畅 ,但均于 6个月内发生再阻塞。结论 鼻泪管支架置入术简单、安全 ,可以门诊治疗 ,但长期通畅率较低 ,支架取出后再阻塞发生率高。

泪道阻塞性疾病的治疗研究进展

近年来,在泪道阻塞性疾病(lacrimal duct obstruction diseases,LDOD)治疗方面取得了较大进展,涌现出了很多新的治疗方法。我们综述了LDOD的药物治疗、泪道探通冲洗治疗、泪囊区按摩治疗、激光泪道成形治疗、高频电灼治疗、泪道支架或人工泪管、手术治疗等方面的研究进展。

泪道阻塞性疾病的诊断研究进展

泪道阻塞性疾病(lacrimal duct obstruction diseases,LDOD)是眼科常见病和多发病。近年来,随着人们对健康要求的提高和医学科学技术的发展,在LDOD的诊断方面取得了较大进展。本文综述了泪道阻塞的病因、检查、诊断和鉴别诊断方面的研究进展。

骨性泪道解剖因素对泪道逆行置管手术疗效的影响

目的分析骨性泪道的解剖因素对泪道逆行置管手术疗效的影响。方法利用CT三维成像技术测量骨性泪道的长度及最小直径后对71例(75眼)原发性泪道阻塞患者行泪道逆行置管手术。结果患者骨性泪道平均长度为(13.52±0.49)mm,最小直径为(3.38±0.34)mm,手术治愈率为62.67%。Logistic回归分析显示骨性泪道长度及最小直径影响泪道逆行置管术的预后。结论通过CT三维重建了解患者的泪道解剖特点,制定个性化的治疗方案,可以提高泪道逆行置管术的治愈率。