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.

Bicanalicular versus monocanalicular intubation after failed probing in congenital nasolacrimal duct obstruction

AIM：To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing.METHODS： This retrospective study was performed on338 patients with the diagnosis of congenital nasolacrimal duct obstruction with age 1-4y that had failed primary probing.Intubation was performed under light sedation in operating room and the stent was left 3mo in place.Clinical outcome was investigated 3mo after tube removal.RESULTS： Bicanalicular intubation method had higher complete and relative success rates compared to monocanalicular intubation（P =0.00）.In addition,Monoka intubation had better outcomes compared to Masterka technique（P =0.046）.No difference was found between genders but the higher the age,the better the outcomes with bicanalicular technique rather than monocanalicular.CONCLUSION： Overall success rate of bicanalicular intubation is superior to monocanalicular technique especially in older ages.Also,based upon our clinical outcomes,Masterka intubation is not recommended in cases of failed probing.

Mode of delivery, birth weight and the incidence of congenital nasolacrimal duct obstruction

AIM: To study any possible association of congenital nasolacrimal duct obstruction(CNLDO) with mode of delivery, birth weight and gestational age. METHODS: We retrospectively reviewed charts of all patients(n=2591) under the age of 3 y who were born between April 2015 and May 2017 and were examined at the Ophthalmology Clinic of Emsey Hospital Istanbul, Turkey. We identified patients(n=105) who were diagnosed as CNLDO. The mode of delivery, birth weight and gestational age along with any adverse event during or after delivery or any other health history were determined. Birth statistical data were obtained from the hospital’s medical records database. RESULTS: Gestational age of babies who were born via cesarean section(CS) was lower than gestational age of babies who were born via normal spontaneous vaginal delivery(NSVD;P=0.002). Babies who were born via CS were found to have 3.75 times higher risk of developing NLDO when compared to babies who were born via NSVD(OR=3.754). CONCLUSION: There is a possible association between CS and CNLDO.

Curative effects of probing alone and probing combined with nasolacrimal injection of levofloxacin ophthalmic gel on congenital duct obstruction of children from 3–12 months of age

Background:To investigate the 1-time success rate of probing alone and nasolacrimal duct probing combined with nasolacrimal injection of levofloxacin ophthalmic gel on congenital nasolacrimal duct obstruction(CNLDO)in young children.Methods:A retrospective case series was performed on 494 cases(647 eyes)of 3–12 month-old children with CNLDO between July 2014 and July 2015.Material obtained from the lacrimal sac was cultured to isolate infectious agents.Susceptibility testing was done.Children from 3–12 months of age who were found to be sensitive to Levofloxacin(n=493 eyes)were separated into two groups:3–6 months of age(276 eyes)and 7–12 months of age(217 eyes).Each of the groups were then randomized into group A(138 eyes of3–6 months of age;102 eyes of 7–12 months of age)and group B(138 eyes of 3–6 months of age;115 eyes of7–12 months of age).Children in group A underwent nasolacrimal duct probing alone;those in group B underwent nasolacrimal duct probing plus nasolacrimal duct injection of levofloxacin and the efficacy of probing was evaluated.Results:The average detection rate of pathogenic bacteria in dacryocystitis was 75.1%,and Staphylococcus aureus was found to be the main pathogenic bacteria(42.59%,106 cases).Among children from 7–12 months of age,the 1-time success rate of nasolacrimal duct probing alone was 88.24%and the 1-time success rate of probing combined with nasolacrimal duct injection of levofloxacin ophthalmic gel was 96.52%(statistical significance,P=0.02<0.05).Conclusions:Most pathogenic bacteria(96.81%)were sensitive to levofloxacin.Nasolacrimal duct probing combined with nasolacrimal duct injection of levofloxacin may improve the success rate of probing in children older than 6 months of age.

Practice patterns among ophthalmic surgeons in treating concomitant oculoplastic conditions in preoperative period:A questionnaire-based study

BACKGROUND Addressing oculoplastic conditions in the preoperative period ensures both the safety and functional success of any ophthalmic procedure.Some oculoplastic conditions,like nasolacrimal duct obstruction,have been extensively studied,whereas others,like eyelid malposition and thyroid eye disease,have received minimal or no research.AIM To investigate the current practice patterns among ophthalmologists while treating concomitant oculoplastic conditions before any subspecialty ophthalmic intervention.METHODS A cross-sectional survey was disseminated among ophthalmologists all over India.The survey included questions related to pre-operative evaluation,anaesthetic and surgical techniques preferred,post-operative care,the use of adjunctive therapies,and patient follow-up patterns.RESULTS A total of 180 ophthalmologists responded to the survey.Most practitioners(89%)felt that the ROPLAS test was sufficient during pre-operative evaluation before any subspecialty surgery was advised.The most common surgical techniques employed were lacrimal drainage procedures(Dacryocystorhinostomy)(63.3%),eyelid malposition repair(36.9%),and ptosis repair(58.7%).Post-operatively,47.7%of respondents emphasized that at least a 4-week gap should be maintained after lacrimal drainage procedures and eyelid surgeries.Sixty-seven percent of ophthalmologists felt that topical anaesthetic procedures should be preferred while performing ocular surgeries in thyroid eye disease patients.CONCLUSION Approximately 50%of ophthalmologists handle prevalent oculoplastic issues themselves,seeking the expertise of an oculoplastic surgeon under particular conditions.Many ophthalmologists still favor using ROPLAS as a preliminary screening method before proceeding with cataract surgery.Eyelid conditions and thyroid eye disease are not as commonly addressed before subspecialty procedures compared to issues like nasolacrimal duct obstruction and periocular infections.

年龄因素对先天性鼻泪管阻塞泪道探通术治疗效果的影响

目的探讨年龄因素对先天性鼻泪管阻塞(CNLDO)泪道探通术治疗效果的影响。方法本研究为单中心回顾性病例研究,采用阶梯式治疗方案对保守治疗无效的患儿适时行泪道探通术,根据患儿年龄分为0~<6月、6~<12月、12~<24月和24~60月龄4组,对比分析各组的手术成功率及其与患儿年龄的相关性。结果共纳入269例患儿314只眼,4个年龄组一次泪道探通成功率分别为86.8%、91.7%、73.6%和37.8%,所有患儿泪道探通总成功率为84.7%(266/314)。12月龄以后探通总成功率下降与年龄增加呈显著相关(P=0.000),与患儿性别和眼别无显著相关性(P=0.255和0.708)。结论阶梯式方案治疗CNLDO安全有效,泪道探通术的成功率与年龄呈负相关,可作为2岁以下患儿保守治疗无效的首选手术方法。

婴幼儿先天性鼻泪管阻塞的治疗探讨

目的：探讨不同年龄阶段的先天性鼻泪管阻塞的婴幼儿,在不同时期采取不同的治疗方法。 方法：将87例102眼患儿分成三个不同的年龄段组：第一组：25天龄~3月龄21例26眼；第二组：〉3~7月龄31例36眼；第三组：〉7~24月龄35例40眼。对第一组实行泪囊鼻泪管按摩＋滴眼液治疗；对第二组进行泪道加压冲洗治疗；对第三组施行鼻泪管探通术治疗。 结果：第一组患儿经泪囊鼻泪管按摩＋滴妥布霉素眼液治疗通畅者12眼,治愈率为46.2%；第二组患儿经泪道加压冲洗治疗通畅者33眼,治愈率为91.7%；第三组患儿经鼻泪管探通术治疗通畅者36眼,治愈率为90.0%。第二组和第三组效果明显优于第一组（χ2=15.71,P〈0.01；χ2=15.27,P〈0.01）；第二组和第三组治疗效果无明显差异（χ2=0.02,P〉0.05）。 结论：婴幼儿先天性鼻泪管阻塞应该区分年龄阶段,采取不同的治疗方法,才能获得较好的治疗效果,而泪道加压冲洗是治疗婴幼儿先天性鼻泪管阻塞的首选方式。

先天性鼻泪管阻塞的综合治疗

目的 先天性鼻泪管阻塞是婴幼儿常见的眼病 ,其处理历来存在争议。本文的研究目的是探讨应用滴抗菌素眼液加泪囊挤压按摩、泪道加压冲洗及鼻泪管探通术的综合治疗方法对先天性鼻泪管阻塞患儿的临床应用价值及其治疗效果。方法我们回顾性分析了 4 83例 54 7眼 ,从 1997年 1月～ 2 0 0 0年 12月在中山眼科中心小儿眼科门诊治疗的先天性鼻泪管阻塞的病例资料 ,首诊平均年龄为 11.8个月。根据患者的年龄和症状 ,分别采用滴抗菌素眼液加泪囊挤压按摩 ,泪道加压冲洗及鼻泪管探通的综合治疗方法进行处理 ,并观察随访 3个月以上 ,症状消失作为治愈的指标。结果 综合治疗方法对先天性鼻泪管阻塞总的治愈率为 97.3 % .其中 6.1%病例用滴抗菌素眼液加泪囊挤压按摩法治愈 ;8.2 %病例用泪道加压冲洗法治愈 ;83 %的病例用鼻泪管探通术治愈。共有 15例患儿在治疗中发生并发症。结论 综合治疗方法对先天性鼻泪管阻塞患儿是安全有效的处理方法。

先天性鼻泪管阻塞的临床治疗

目的探讨先天性鼻泪管阻塞的不同治疗方法和时机。方法回顾分析了735例837眼在复旦大学附属儿科医院诊断为先天性鼻泪管阻塞的患儿,平均首诊年龄4.5个月。根据首诊年龄依次采用保守治疗、加压泪道冲洗和泪道探通法。随访3～16个月,平均6.4个月,以溢泪症状完全消失作为治愈指标。结果保守治疗法治疗837眼,治愈123眼,治愈率14.7;加压泪道冲洗法治疗714眼,治愈181眼,治愈率25.4;泪道探通法治疗533眼,治愈518眼,治愈率97.2.早期探通(≤6个月龄组)一次成功率为87.7;后期探通(>6个月龄组)一次成功率为56.6.结论泪道探通法治疗先天性鼻泪管阻塞安全有效,最佳干预时机为4～6个月龄。

先天性鼻泪管阻塞的临床特点及泪道探通术效果的影响因素

目的:探讨先天性鼻泪管阻塞的临床特点及影响泪道探通术效果的因素。方法:本研究通过回顾性分析2010-06/2011-05在我院眼科就诊并行泪道探通术的先天性鼻泪管阻塞的患儿616例687眼,研究内容包括:初次就诊年龄、泪道探通术时年龄、性别、分娩方式、有无脓性分泌物、既往泪道冲洗和泪道探通术病史。总结其临床特点并通过分析以上各因素与泪道探通术成功率的关系,研究先天性鼻泪管阻塞治疗效果的影响因素。泪道探通术成功的标准为:流泪和眼部分泌物等症状消失,泪道冲洗通畅。结果:剖宫产和自然分娩患儿在泪道探通术成功率方面没有统计学差异(P=0.376),男女之间也没有统计学差异(P=0.498)。泪道探通术成功率与泪道探通术年龄呈负相关关系(r=-0.328,P=0.001)。3～,6～,9～,12～15,>15月龄手术成功率分别为:100%,97.8%,90.8%,83.3%和76.5%。有脓性分泌物的患儿手术成功率明显下降(P=0.013)。患儿既往泪道冲洗病史对泪道探通术成功率影响不大(P=0.561)。但有外院泪道探通术病史的患儿,其手术成功率显著下降(P=0.042)。结论:先天性鼻泪管阻塞的泪道探通术成功率随着年龄的增长而下降,而且脓性分泌物也是泪道探通术失败的危险因素。因此对于先天性鼻泪管阻塞的患儿,有效局部控制炎症和早期行泪道探通术是提高泪道探通术成功率的关键。

先天性鼻泪管阻塞致泪囊炎的病原菌及药敏结果分析

目的:分析小儿先天性鼻泪管闭塞所致泪囊炎的病原菌及其药敏结果,指导临床合理用药。方法:对先天性鼻泪管阻塞患儿98例110眼的泪囊分泌物进行病原菌分离培养及药物敏感试验。结果:从94眼的分泌物中共分离出155株细菌,病原菌阳性率为85.5%。其中革兰氏阳性球菌65.8%,革兰氏阴性杆菌23.9%。分离出的所有菌株对左氧氟沙星的敏感率为94.2%。结论:药敏试验表明绝大多数细菌对左氧氟沙星有较高的敏感性,对于小儿先天性鼻泪管闭塞所致泪囊炎可给予新喹诺酮类抗生素滴眼液治疗。

新型泪道探通针治疗先天性泪道阻塞临床分析(英文)

目的:根据患儿年幼、头部易摆动、针头难固定易滑脱、组织娇嫩、不宜探针反复进出泪道操作等特点,探讨新型泪道探通针治疗婴幼儿先天性泪道阻塞(nasolacrimal duct obstruction,NLDO)的临床疗效。方法:用新型泪道探通针对眼科门诊2568例2771眼先天性NLDO患者进行泪道探通,并观察疗效。结果:所有患者手术成功,其中一次探通成功2722眼(98.23%),二次探通成功49眼(1.77%),除极少数患儿有轻度眼睑水肿外,无任何严重并发症发生。结论:新型泪道探通针设计合理、操作方便、安全实用,对泪道无损伤、独立包装、消毒彻底、能避免交叉感染、价格低廉、临床应用效果良好,尤其适合婴幼儿患者,值得推广使用。

泪道探通联合典必殊眼液在先天性泪道阻塞治疗中的应用

目的:评价泪道探通术联合典必殊眼液治疗先天性泪道阻塞是否优于传统典必殊眼膏注入。方法:回顾性分析某医院先天性泪道阻塞患儿(6个月~8岁)424例(525眼)临床资料。根据术中注入典必殊眼液或眼膏分为眼液组(219例,274眼)或眼膏组(205例,251眼)。比较两组临床特征及手术成功率。结果:典必殊眼液组的手术总成功率达98.2%,显著优于眼膏组82.9%。两组之间的差异随年龄增大而增加。1~2岁患儿眼液组成功率达96.5%,眼膏组为60.4%;大于2岁患儿眼液组手术成功率达91.3%,典必殊眼膏组为51.6%。结论:泪道探通术联合典必殊眼液治疗先天性泪道阻塞疗效佳。

软探针泪道探通术治疗先天性泪道阻塞和泪囊炎的护理

目的探讨软探针泪道探通术治疗先天性泪道阻塞和泪囊炎的效果。方法回顾性分析119例(133眼)先天性泪道阻塞和泪囊炎用软探针泪道探通术治疗的护理体会。结果随访3～6个月(平均4个月),57例(65眼)先天性鼻泪管阻塞治愈率达98.5%;62例(68眼)先天性泪囊炎治愈率为95.6%。未发生1例假道和泪小管损伤。结论掌握泪道探通及泪道冲洗的技巧,术后观察及处理是软探针泪道探通术成功的关键。

先天性鼻泪管阻塞与分娩方式的临床研究

目的研究先天性鼻泪管阻塞(CNDO)患儿的病史资料,总结本病的发病与产妇分娩方式的相关性。方法选取2007年7月-2011年7月间于唐山市妇幼保健院进行诊治最终确诊为CNDO的1 322例患儿,共1 498只眼,其中780例为男孩,542例为女孩,对这些患儿的临床资料进行分析总结。结果 CNDO的患儿中顺产的有500例,占37.82%;剖腹产的有822例患儿,占62.18%;两种生产方式进行比较,剖腹产的患儿出现CNDO的几率明显高于顺产的患儿,两种生产方式比较,差异有统计学意义(P<0.05)。对两组患儿的膜性阻塞例数进行分析,经剖腹产的患儿发病例数明显高于顺产的患儿数量,但两种生产方式的泪道狭窄数量及骨性阻塞数量比较,差异无统计学意义(P>0.05)。结论胎儿在娩出体外的过程中,经阴道分娩时受到产道的挤压,可能会使封闭的残膜破裂,变为开放状态,而且本文的研究也表明剖腹产患儿的例数明显高于顺产患儿的数量,这就说明分娩方式在一定程度上影响了CNDO的发生率,应得到临床医生的足够重视。

早期泪道探通术治疗先天性鼻泪管阻塞的疗效观察

目的探讨先天性鼻泪管阻塞(congenital nasolacrimal duct obstruction,CNLDO)的最佳治疗时机,阻塞部位的不同对探通术成功率的影响,以及重复探通术的成功率。方法对804例(976只眼)1～48个月CNLDO患儿行表面麻醉下泪道探通术,按不同年龄组、不同阻塞部位和重复探通术的疗效进行回顾性分析。结果经过治疗治愈958只眼,总治愈率为98.2%。不同年龄组探通成功率差异有统计学意义(χ2=163.9,P<0.005),其中1～3个月婴儿的成功率为98.5%,高于其他年龄组。66只眼接受二、三次探通术,主要是鼻泪管多处阻塞者,占84.8%。一次探通的治愈率与二、三次探通的治愈率差异有统计学意义(χ2=186.0,P<0.005);二次探通与三次探通比较,差异无统计学意义(χ2=0.18,P>0.025)。结论 CNLDO患儿选择早期泪道探通的最佳治疗时机是1～3个月,鼻泪管多处阻塞患儿重复探通率高,2～3次探通不成功者应尽早采用其他方法进行治疗。

激光泪道成形术治疗难治性先天性鼻泪管阻塞

目的 评价激光泪道成形术治疗难治性先天性鼻泪管阻塞的效果。方法 采用KTP激光泪道成形术对 15例 (15眼 )难治性先天性鼻泪管阻塞患儿进行治疗 ,观察其临床效果。结果 术后随访 6～ 2 4个月 ,治愈率为 93 3% ,无并发症发生。结论 激光泪道成形术能够安全、有效治疗难治性先天性鼻泪管阻塞。

常规探通术不能疏通的婴幼儿先天鼻泪管阻塞的CT-DCG特征及手术方式选择

目的研究常规探通术不能疏通的婴幼儿先天鼻泪管阻塞的CT泪道造影(CTDCG)的特征及其对手术方式选择的指导意义,对婴幼儿先天鼻泪管阻塞的诊断和治疗提供影像学依据。方法回顾性分析常规探通术不能疏通的先天鼻泪管阻塞的婴幼儿患者34例(41只眼)的病例资料。患者均做CT泪道造影多平面重组检查,显示鼻泪管的冠状位、矢状位和水平位,分析骨性鼻泪管的CT影像特征,包括骨性鼻泪管的走行方向、宽度、形状等,并对CT造影指导下选择的手术方式的治疗效果进行分析。结果(1)CT影像特征:34例患儿中骨性鼻泪管走行呈弓形内弯曲畸形11例(13只眼),外下方斜畸形6例(6只眼),矢状位骨性鼻泪管上段的前壁呈鹰嘴样后弯3例(3只眼),骨性鼻泪管闭锁9例(12只眼),骨性鼻泪管重度狭窄6例(7只眼);(2)分类:按闭锁和重度狭窄的部位不同,骨性鼻泪管闭锁和重度狭窄又可为骨性鼻泪管上段、中段、下段闭锁或重度狭窄。其中以骨性鼻泪管中段和下段同时闭锁或重度狭窄较多,分别为8例(10只眼)和4例(5只眼);(3)手术情况:根据CT造影检查结果选择合适的手术方式,术中所见均与泪道CT造影多平面重组检查结果相符,患者手术后均治愈。结论常规探通术不能疏通的婴幼儿先天鼻泪管阻塞的患者的骨性鼻泪管形状多样,并非都是骨性阻塞;CT泪道造影多平面重组检查能清晰地显示鼻泪管的情况,有助于明确不能探通的原因,对选择合适的手术方式有较好的指导意义。

鼻泪管植管治疗婴幼儿先天性鼻泪管阻塞104例

目的观察鼻泪管植管治疗婴幼儿先天性鼻泪管阻塞的临床疗效。方法对104例(118眼)先天性鼻泪管阻塞的婴幼儿用鼻泪管植管治疗进行观察。结果 104例(118眼)先天性鼻泪管阻塞全部治愈,有效率100.00%,治愈率94.06%。结论鼻泪管植管操作方便,对泪道无损伤,治疗婴幼儿先天性鼻泪管阻塞效果良好。

婴幼儿先天性鼻泪管阻塞的综合治疗

目的探讨应用抗生素眼液滴眼加泪囊区按摩法、泪道加压冲洗法、鼻泪管探通术综合治疗婴幼儿先天性鼻泪管阻塞的临床应用价值及治疗效果。方法回顾自2000年11月～2005年5月在我院眼科门诊治疗的382例(419眼)婴幼儿先天性鼻泪管阻塞的病历资料,首诊年龄3d～6y。根据患者年龄和症状分别采用抗生素眼液滴眼加泪囊区按摩法、泪道加压冲洗法、鼻泪管探通术的综合治疗进行处理,并随访6个月以上。以无泪溢,眼无分泌物,泪道冲洗通畅或极少返流为治愈标准。结果综合治疗治愈率97.1%,其中5.5%为抗生素眼液滴眼加泪囊区按摩法治愈,11.2%为泪道加压冲洗法治愈,80.4%鼻泪管探通术治愈。2.9%的病例未愈,2.3%病例发生并发症。结论综合治疗婴幼儿先天性鼻泪管阻塞是行之有效且风险较小的一种治疗方法。