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.

Laser-assisted dacryocystorhinostomy in nasolacrimal duct obstruction：5-year follow-up

AIM：To evaluate the long-term sucess rate of laserassisted dacryocystorhinostomy （L-DCR） in patients with nasolacrimal duct obstruction （NDO）.METHODS：Forty-one eyes of forty patients aged between 21-85y （mean 56.7y） who underwent L-DCR for the treatment of NDO were included in this retrospective,non-randomized study. The follow-up time was 72mo.Functional sucess was defined as the disappearance of epiphora under normal conditions and the presence of a patent ostium on lacrimal irrigation. Anatomical success was defined as a patent lacrimal passage on syringing besides continuing epiphora. Surgical failure was defined as persistent epiphora and closed ostium.RESULTS：Twenty-seven of 40 patients （67.5%） were female and 13 of 40 patients （32.5%） were male. The NDO was right-sided in 17 （42.5%） patients and left-sided in 22（55%） patients whereas 1 （2.5%） patient had undergone bilateral surgery. In 11 （27.5%） patients there were additional nasal abnormalities requiring simultaneous surgical approach. The average time for L-DCR was 26.50±4.9min（16-39min） and the average total amount of laser energy used was 287±27.9 J （239-367 J）. At the 5y follow-up, anatomical sucess rate was 75.0%（30 patients） and functional success rate was 65.0%（26 patients）, whereas surgical failure was seen in 25%（10 patients）. Revision of surgery was performed in 10 cases （25.0%）; failure of revision surgery was seen in 2 cases（5.0%）.CONCLUSION： Transcanalicular L-DCR is a reliable and fast procedure in the treatment of NDO. It can be alternative to external DCR which is accepted as the gold standard currently. The functional and anatomical success rate is higher in the first months and years, but still satisfactory at fifth year.

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.

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.

Diagnosis and Treatment of Lacrimal Passage Obstruction by Lacrimal Endoscope

The diagnosis and treatment of the lacrimal passage obstruction with lacrimal endoscope was investigated and its subsidiary surgical procedures were evaluated. Ninety-three patients （109 eyes） with lacrimal passage obstruction, including presaccal canalicular obstruction （PSCO） and nasolacrimal duct obstruction （NLDO）, were examined under a lacrimal endoscope, and the obstruc- tions were treated with laser or micro-drill. All patients were followed up after the operation for 3--6 months. The difference between the laser and the micro-drill treatment was observed. During the period of follow-up, the curative rate was 82.57%. The healing rate in PSCO group and NLDO was 80.36% and 84.91% respectively （P〉0.05）. Alter treatment with the laser, the healing rate was 93.33% in the PSCO group and 66.67% in the NLDO group respectively （P〈0.05）. After treatment with the micro-drill, the healing rate in PSCO and NLDO groups was 65.39% and 94.28% respec- tively （P〈0.01）. The lacrimal passage obstruction can be observed and treated directly through the lacrimal endoscope. Choosing different surgical procedures in operation according to the locations of the obstruction is helpful to improve the effectiveness.

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.

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。

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。

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.

精囊镜下铥激光治疗射精管梗阻的临床结局分析

目的:评估射精管梗阻所致的少精子症或无精子症患者行精囊镜下铥激光烧灼术治疗后的临床结局。方法:回顾性分析2018年4月至2020年1月42例南京医科大学第一附属医院泌尿外科男科门诊因射精管梗阻导致的少弱精子症或无精子症患者的临床资料,术前均经相关检查诊断明确,术中利用精囊镜寻找射精管开口,铥激光技术解除射精管梗阻,术后定期随访,监测患者精液常规变化,对手术前后参数采用t检验。结果:42例患者术前完善相关检查,均行经尿道精囊镜探查,并辅以铥激光治疗射精管梗阻,平均手术时间为52.7 min,与患者术前两周精液常规相比,患者术后3个月,6个月及9个月精液体积,精子浓度,精子总活力显著改善(P<0.05),所有患者精液常规中均发现精子,其中40例患者于术后3个月内于精液常规中发现精子,2例患者于术后6~9月于精液常规中发现精子,其中7例患者出现术后并发症,包括附睾炎,会阴部或睾丸疼痛及术后血尿,经相应对症治疗后症状消失,所有病例术后均未出现逆行射精,直肠损伤,尿道狭窄或尿失禁等严重并发症。结论:作为治疗射精管梗阻的强有力武器,精囊镜探查辅以铥激光技术可行,术后并发症较少,患者术后精子质量恢复较好,是治疗射精管梗阻性少弱精子症安全且有效的手段。

泪道高频治疗仪联合RS泪道再通管对鼻泪管阻塞的治疗效果研究

目的:探讨泪道高频治疗仪联合RS泪道再通管对鼻泪管阻塞的治疗效果。方法:前瞻性选取2018年5月至2020年1月于某院接受治疗的鼻泪管阻塞患者158例,随机分为对照组(79例,82眼)和观察组(79例,85眼),分别进行疏通术联合药物治疗和泪道高频治疗仪联合RS泪道再通管治疗。比较2组基线资料、临床疗效、泪液弯液面水平、泪膜破裂时间、泪液分泌量、不良反应以及并发症情况。采用SPSS 16.0软件进行统计学分析。结果:观察组总有效率明显高于对照组(92.94%vs 71.95%,P<0.05)。2组治疗后各时间点泪液弯液面水平均较治疗前降低且观察组低于对照组(P<0.05)。组间以及组内不同时间点泪膜破裂时间差异无统计学意义(P>0.05)。观察组治疗1周、1个月、3个月后泪液分泌量高于对照组(P<0.05),治疗9个月后泪液分泌量低于对照组(P<0.05)。2组不良反应和并发症总发生率差异无统计学意义(χ^(2)=0.995,P=0.318)。结论:泪道高频治疗仪联合RS泪道再通管治疗鼻泪管阻塞能明显提高临床疗效、降低泪液弯液面水平、改善溢泪症状,同时不影响泪膜破裂时间,未增加不良反应和并发症,值得在临床上推广应用。

鼻内镜下鼻腔泪囊吻合术治疗泪道阻塞性疾病的临床效果

目的探讨鼻内镜下鼻腔泪囊吻合术(DCR)治疗泪道阻塞性疾病的临床效果。方法选取2019年8月至2021年8月本院收治的100例泪道阻塞性疾病患者作为研究对象,采用随机数字表法分为对照组与研究组,每组50例。对照组采用传统外路DCR治疗,研究组采用鼻内镜下DCR治疗,比较两组治疗后手术指标、临床疗效、术后并发症发生情况、生命质量、复发情况。结果研究组治疗总有效率显著高于对照组(P<0.05);研究组术中出血量、VAS评分及术后复发率均低于对照组,住院时间短于对照组,差异有统计学意义(P<0.05);研究组术后并发症发生率低于对照组,差异有统计学意义(P<0.05);术后,两组心理功能、社会功能、生理功能、精神状态评分均高于术前,且研究组高于对照组,差异有统计学意义(P<0.05)。研究组复发率低于对照组,差异有统计学意义(P<0.05)。结论鼻内镜下鼻腔泪囊吻合术治疗泪道阻塞性疾病疗效显著,具有术中出血量少、疼痛程度轻、康复速度快、复发率、并发症发生率低等优势,可改善患者生命质量,值得临床推广应用。

妥布霉素、地塞米松联合泪道探通术治疗泪道阻塞的效果观察

目的:观察妥布霉素、地塞米松联合泪道探通术治疗泪道阻塞的临床效果。方法:选取87例泪道阻塞患者,随机数字表法分为对照组和研究组。对照组44例行泪道探通术治疗,研究组43例在对照组基础上加用妥布霉素和地塞米松治疗,观察、分析两组治疗效果。结果:研究组治疗总有效率90.70%高于对照组68.18%,差异有统计学意义(P<0.05)。治疗后,眼表疾病指数量表(OSDI)评分、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)水平低于对照组(P<0.05)。结论:妥布霉素、地塞米松联合泪道探通术治疗泪道阻塞可降低炎性因子水平,改善眼部症状,提高临床治疗效果。

应用激光治疗慢性泪道阻塞性疾病的几个问题

应用激光治疗各种慢性泪道阻塞性疾病操作简便,安全性好,组织损伤小,疗效可靠,目前已得到较为广泛的开展。本文就有关值得注意的几个问题,如适应症的选择,一些特殊类型泪道阻塞的治疗,在激光治疗过程中和术后的处理,丝裂霉素C(MMC)的应用,假道的预防和复发问题以及激光能量的掌握等进行了讨论。

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。

盐酸赛洛唑啉喷鼻联合泪道激光置管术治疗鼻泪管阻塞

目的:研究鼻腔炎症对鼻泪管阻塞的影响,探讨赛洛唑啉鼻喷雾剂在鼻泪管阻塞治疗中的作用,为泪道病治疗及病因分析提供依据。方法:收集鼻泪管阻塞患者279例,所有研究对象术前行泪道冲洗、泪道CT造影、鼻内镜检查。279例患者均行泪道激光成型+置管术,A组137例患者术后抗生素及非甾体抗炎药滴眼液点眼,B组142例患者术后抗生素及非甾体抗炎药滴眼液点眼联合赛洛唑啉鼻喷雾剂喷鼻治疗。结果:参与研究的279例患者中,有217例(77.8%)患者鼻腔有炎症表现,其中A组105例(76.6%),B组112例(78.9%),主要为鼻腔黏膜充血、下鼻甲肥大、中鼻甲肥大等。拔管3mo后,A组137例患者有效率为86.1%,B组142例患者有效率为95.8%,差异有统计学意义(P<0.05)。结论:鼻腔炎症是鼻泪管阻塞发病的重要因素,在泪道阻塞的诊疗过程中,临床医生需重视鼻腔炎症的治疗,泪道激光成型+人工鼻泪管置入术联合盐酸赛洛唑啉鼻用喷雾剂喷鼻治疗鼻泪管阻塞可明显提高鼻泪管阻塞的治愈率。