Oculoplastic and Orbital Division, Department of Ophthalmology & Visual Sciences, University of Adelaide, and South Australian Institute of Ophthalmology, Adelaide, Australia.
Ophthalmology. 2013 Aug;120(8):1688-92. doi: 10.1016/j.ophtha.2013.01.023. Epub 2013 May 1.
To describe the incidence of canalicular closure with powered endonasal dacryocystorhinostomy (DCR) without canalicular intubation in primary acquired nasolacrimal duct obstruction (PANDO).
A single-surgeon, prospective, nonrandomized, noncomparative, interventional case series.
Consecutive patients attending a specialist clinic of an oculoplastic surgeon (DS) with radiologically confirmed diagnosis of PANDO. Cases of canalicular disease were excluded.
Patients with radiologically confirmed PANDO without canalicular involvement underwent endonasal DCR without intubation. The operation was performed by 1 surgeon (DS) and follow-up was at 4 weeks and 12 months.
Outcomes were recorded as subjective symptomatic relief at 12 months and endoscopic evidence of ostium patency and canalicular patency.
There were 132 cases that fulfilled the inclusion criteria. Three cases were lost to follow-up. Preoperatively, 96.3% of cases had Munk scores of >2. Of the 129 cases, 127 (98.5%) had endoscopic evidence of a patent ostium with a positive endoscopic dye test at the 12-month follow-up. All cases had a patent canalicular system as demonstrated by syringing and probing. Of the 129 cases, 117 (90.7%) had subjective improvement of epiphora at 12 months with 88.4% of cases reporting Munk scores of ≤1.
In this prospective series of nonintubation for PANDO, there were no cases of canalicular closure or stenosis at 12 months. Anatomic and functional success was similar to reported outcomes for DCR with intubation for PANDO. We advocate that routine intubation for the purpose of maintaining canalicular patency is not necessary when performing endonasal DCR in PANDO.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
描述原发性获得性鼻泪管阻塞（PANDO）患者在接受经鼻内镜鼻腔泪囊吻合术（DCR）时不进行泪小管插管时的泪小管闭合发生率。
单外科医生、前瞻性、非随机、非对照、干预性病例系列研究。
连续就诊于眼科整形医生（DS）专科门诊并经放射学证实为 PANDO 诊断的患者。排除有泪小管疾病的病例。
经放射学证实患有 PANDO 且无泪小管受累的患者接受了不插管的经鼻内镜 DCR。手术由 1 名外科医生（DS）进行，随访时间为 4 周和 12 个月。
记录 12 个月时的主观症状缓解情况以及内镜下吻合口通畅和泪小管通畅的证据。
共有 132 例符合纳入标准，3 例失访。术前，96.3%的病例 Munk 评分>2。在 129 例病例中，127 例（98.5%）在 12 个月的随访时内镜下可见吻合口通畅，且经内镜染料试验阳性。所有病例均通过冲洗和探查证实泪小管系统通畅。在 129 例病例中，117 例（90.7%）在 12 个月时流泪症状改善，88.4%的病例报告 Munk 评分≤1。
在本前瞻性、非插管的 PANDO 病例系列研究中，12 个月时没有泪小管闭合或狭窄的病例。解剖学和功能成功率与 PANDO 插管 DCR 报道的结果相似。我们主张，在 PANDO 行经鼻内镜 DCR 时，为保持泪小管通畅而常规插管没有必要。
