Ibrahim H A, Noble J L, Batterbury M, Johnson C P, Williams R
Department of Ophthalmology, Alexandria University Hospital, Alexandria, Egypt.
Ophthalmology. 2001 Dec;108(12):2337-45; discussion 2345-6. doi: 10.1016/s0161-6420(01)00813-2.
(1) Test the feasibility and the safety of guided transnasal trephination in creating a nasolacrimal fistula. (2) Develop an appropriate lacrimal maintainer and test its value in modulating healing at the fistula site.
Prospective, noncomparative interventional case series.
Five cadavers and 19 patients.
A transcanalicular lacrimal probe penetrated the lacrimal fossa to guide the passage of a flexible trephine up the nose, which created the nasolacrimal communication. A special wide-caliber lacrimal maintainer was inserted along lacrimal tubes within the created passage.
For cadaveric study, direct inspection after dissection of the facial flap was performed. For the clinical trial, subjective improvement in watery eye, dye testing, lacrimal probing, lacrimal irrigation, and endoscopic nasal examination.
The technique resulted in the creation of a regular fistula of reproducible diameter into which a standard-shaped wide caliber maintainer could be inserted. Three months after removal of the maintainer and 6 months after surgery, a patent ostium was achieved in 17 of 18 (94%) patients who had a completed procedure. Relief of symptoms was achieved in 83%.
Guided endoscopic dacryocystorhinostomy provides a simple and safe option for the treatment of nasolacrimal duct obstruction. The lacrimal maintainer is a useful device to achieve a large patent nasolacrimal communication.
（1）测试经鼻引导钻孔形成鼻泪瘘的可行性和安全性。（2）研发一种合适的泪道支撑器，并测试其在调节瘘口部位愈合方面的价值。
前瞻性、非对照性干预病例系列研究。
5具尸体和19名患者。
经泪小管泪道探针穿透泪囊窝，引导柔性环钻经鼻腔穿出，从而建立鼻泪通道。沿所建立通道内的泪道插入一种特殊的宽口径泪道支撑器。
尸体研究中，在面部皮瓣解剖后进行直接检查。临床试验中，观察泪溢主观改善情况、染料试验、泪道探查、泪道冲洗及鼻内镜检查结果。
该技术可形成直径可重复的规则瘘口，可插入标准形状的宽口径支撑器。在完成手术的18例患者中，17例（94%）在取出支撑器3个月及术后6个月时实现了瘘口通畅。83%的患者症状得到缓解。
内镜引导下泪囊鼻腔造口术为鼻泪管阻塞的治疗提供了一种简单且安全 的选择。泪道支撑器是实现较大的通畅鼻泪通道的有用器械。
