Arch Ophthalmol. 2012 Dec;130(12):1525-33. doi: 10.1001/archophthalmol.2012.2853.
To compare the cost-effectiveness of 2 approaches for treating unilateral nasolacrimal duct obstruction (NLDO).
One hundred sixty-three infants aged 6 to less than 10 months with unilateral NLDO were randomly assigned to receive immediate office-based nasolacrimal duct probing (n = 82) or 6 months of observation/nonsurgical management (n = 81) followed by probing in a facility for persistent symptoms.
Treatment success was defined as the absence of clinical signs of NLDO (epiphora, increased tear lake, mucous discharge) on masked examination at age 18 months. Cost of treatment between randomization and age 18 months included costs for all surgical procedures and medications.
In the observation/deferred facility-probing group, NLDO resolved within 6 months without surgery in 44 of the 67 patients (66%; 95% CI, 54% to 76%) who completed the 6-month visit. Twenty-two (27%) of the 81 patients in the observation/deferred facility-probing group underwent surgery, 4 of whom were operated on within the initial 6 months. At age 18 months, 69 of 75 patients (92%) in the immediate office-probing group were treatment successes, compared with 58 of 71 observation/deferred facility-probing group patients (82%) (10% difference in success; 95% CI, -1% to 21%). The mean cost of treatment was $562 in the immediate office-probing group compared with $701 in the observation/deferred facility-probing group (difference, -$139; 95% CI, -$377 to $94). The immediate office-probing group experienced 3.0 fewer months of symptoms (95% CI, -1.8 to -4.0).
The immediate office-probing approach is likely more cost-effective than observation followed by deferred facility probing if needed. Adoption of the immediate office-probing approach would result in probing in approximately two-thirds of infants whose obstruction would have resolved within 6 months of nonsurgical management, but would largely avoid the need for probing under general anesthesia.
Although unilateral NLDO often resolves without surgery, immediate office probing is an effective and potentially cost-saving treatment option.
clinicaltrials.gov Identifier: NCT00780741.
比较两种治疗单侧鼻泪管阻塞（NLDO）方法的成本效益。
163例6至未满10个月的单侧NLDO婴儿被随机分配接受即刻门诊鼻泪管探通术（n = 82）或6个月观察/非手术治疗（n = 81），之后对持续有症状者在医疗机构进行探通术。
治疗成功定义为18个月龄时在盲法检查中无NLDO的临床体征（溢泪、泪湖增大、黏液性分泌物）。随机分组至18个月龄的治疗成本包括所有手术操作和药物的费用。
在观察/延迟机构探通组中，67例完成6个月访视的患者中有44例（66%；95%CI，54%至76%）在6个月内未手术而鼻泪管阻塞自行缓解。观察/延迟机构探通组的81例患者中有22例（27%）接受了手术，其中4例在最初6个月内进行了手术。在18个月龄时，即刻门诊探通组的75例患者中有69例（92%）治疗成功，而观察/延迟机构探通组的71例患者中有58例（82%）治疗成功（成功差异为10%；95%CI，-1%至21%）。即刻门诊探通组的平均治疗成本为562美元，而观察/延迟机构探通组为701美元（差异为 - 139美元；95%CI，-377美元至94美元）。即刻门诊探通组的症状持续时间少3.0个月（95%CI，-1.8至-4.0）。
如果需要，即刻门诊探通法可能比观察后延迟机构探通更具成本效益。采用即刻门诊探通法将导致约三分之二阻塞在非手术治疗6个月内可自行缓解的婴儿接受探通，但很大程度上可避免全身麻醉下的探通需求。
虽然单侧NLDO通常无需手术即可缓解，但即刻门诊探通是一种有效且可能节省成本的治疗选择。
clinicaltrials.gov标识符：NCT00780741。
