Lunardelli Patrícia, Aoki Lísia, Jervásio Ana Carolina, Zagui Roberta Melissa Benetti, Matayoshi Suzana
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Arq Bras Oftalmol. 2008 Jan-Feb;71(1):110-4. doi: 10.1590/s0004-27492008000100024.
Epiphora (watering eye) is generally caused by insufficient drainage of tears. The most common cause of epiphora in adults is idiopathic inflammatory obstruction of the nasolacrimal duct. The traditional surgical treatment of nasolacrimal duct obstruction is an external dacryocystorhinostomy, which has an 85% to 95% success rate. To eliminate cutaneus wounds and scarring some techniques were introduced, for example the endonasal laser dacryocystorhinostomy and the nasolacrimal stent. The aim of this report was to evaluate the first case of nasolacrimal stent implantation in Brazil. The procedure was performed in the "Hospital das Clínicas" of the University of São Paulo - USP. A female patient with tearing of the right eye and secretion was submitted to a nasolacrimal stent implantation, with fluoroscopic guidance. The stent used in this procedure was the polyurethane Tearleader stent set. (Dr. Wilhelm type-PBN MEDICALS - Denmark). After 3 months, the patient started complaining of tearing, so the stent was removed and the patient was submitted to an external dacryocystorhinostomy. At present the patient does not have any symptoms or complaints. This procedure is less invasive and simple, causes no facial scars and avoids surgical trauma, but the long term success rates achieved using polyurethane nasolacrimal stents are low as compared with the external dacryocystorhinostomy. In addition, the patients usually complaint of tearing even having patent lacrimal system. In summary, long-term studies are needed to resolve some complications. Maybe a new stent design and new methods of unblocking the stent in situ would improve in the near future the levels of patency that currently are modest.
溢泪(流泪)通常是由泪液引流不足引起的。成年人溢泪最常见的原因是鼻泪管特发性炎性阻塞。鼻泪管阻塞的传统手术治疗是外路泪囊鼻腔吻合术,成功率为85%至95%。为了消除皮肤伤口和瘢痕,引入了一些技术,例如鼻内镜激光泪囊鼻腔吻合术和鼻泪管支架。本报告的目的是评估巴西首例鼻泪管支架植入病例。该手术在圣保罗大学 - USP的“临床医院”进行。一名右眼流泪并有分泌物的女性患者在荧光透视引导下接受了鼻泪管支架植入术。本手术使用的支架是聚氨酯泪导支架套装(Wilhelm博士型 - PBN MEDICALS - 丹麦)。3个月后,患者开始抱怨流泪,因此取出支架,患者接受了外路泪囊鼻腔吻合术。目前患者没有任何症状或不适。该手术侵入性较小且操作简单,不会造成面部瘢痕,避免了手术创伤,但与外路泪囊鼻腔吻合术相比,使用聚氨酯鼻泪管支架获得的长期成功率较低。此外,即使泪道通畅,患者通常也会抱怨流泪。总之,需要进行长期研究以解决一些并发症。也许在不久的将来,新的支架设计和原位疏通支架的新方法将提高目前尚不理想的通畅率。