Ho Thomas, Lee Vickie
Central Eye Department, Central Middlesex Hospital, Acton Lane, Park Royal, London NW10 7NS, UK.
Clin Exp Ophthalmol. 2006 Jan-Feb;34(1):39-43. doi: 10.1111/j.1442-9071.2006.01137.x.
The management of lacrimal canalicular injury is controversial. It is believed that practice varies widely among surgeons.
One hundred and twenty National Health Service-based Consultant Ophthalmologists with oculoplastic interest across the United Kingdom (UK) were identified via the website http://www.specialistinfo.com, which is a website that asks UK consultants to identify their areas of subspecialty interests. Questionnaires were sent out to them to determine caseload, intraoperative techniques (magnification, suture and stents) and postoperative management (antibiotic use, stent placement and replacement and secondary lacrimal surgery) of patients with canalicular injuries.
Eighty-nine (74%) completed questionnaires were returned and analysed. Most (63%) of the respondents treated between one and five canalicular injuries over the past year. Thirty-eight (43%) of them would repair a monocanalicular injury only if the lower canaliculus was involved and 36 (40%) respondents would always repair a monocanalicular injury. Eighty-two (92%) respondents used magnification during surgery. Fifty-one (57%) respondents would never consider using the pigtail probe. Eighty-five (96%) would use the bubble test and/or fluorescein dye to locate the severed medial canalicular end. Vicryl or dexon was the suture of choice for 76 (85%) and 63 (71%) respondents for repairing pericanalicular and canalicular tissues, respectively. Thirteen (14.6%) respondents did not stent their canalicular repairs. Forty-seven (53%) routinely used prophylactic antibiotics. Sixty-eight (76%) respondents would wait between 3 and 12 months before undertaking further lacrimal surgery.
This study confirmed that management of lacrimal canalicular injury varies widely among surgeons in the UK.
泪小管损伤的处理存在争议。据信外科医生的做法差异很大。
共收回并分析了89份（74%）完成的问卷。大多数（63%）受访者在过去一年中治疗了1至5例泪小管损伤。其中38人（43%）仅在下部泪小管受累时才会修复单泪小管损伤，36人（40%）的受访者会一直修复单泪小管损伤。82人（92%）的受访者在手术中使用了放大设备。51人（57%）的受访者从未考虑使用猪尾探针。85人（96%）会使用气泡试验和/或荧光素染料来定位切断的内侧泪小管断端。对于修复泪小管周围组织和泪小管组织，分别有76人（85%）和63人（71%）的受访者选择使用薇乔缝线或聚乙醇酸缝线。13人（14.6%）的受访者在泪小管修复时未置入支架。47人（53%）常规使用预防性抗生素。68人（76%）的受访者会在3至12个月后再进行进一步的泪道手术。
本研究证实，英国外科医生对泪小管损伤的处理差异很大。
