Dacryology Service, L. V. Prasad Eye Institute , Hyderabad , India and.
Ocul Immunol Inflamm. 2013 Dec;21(6):417-23. doi: 10.3109/09273948.2013.797473. Epub 2013 Aug 7.
To study the changes in the lacrimal drainage-associated lymphoid tissue of the lacrimal sac in human chronic dacryocystitis and its possible implications in understanding the immune defense mechanisms and etiopathogenesis of primary acquired nasolacrimal duct obstruction.
Retrospective interventional study involving 200 lacrimal sacs of 164 consecutive patients seen between July 2009 and July 2012. Data collected include demographics, clinical presentation, laterality, age at presentation, duration of symptoms, diagnostic irrigation, indications for a dacyrocystectomy, pattern and severity of lymphoid infiltrate, types of lymphoid follicles and their locations, plasma cells, and other cellular infiltrates. The associated epithelial, stromal, and luminal changes with an emphasis on acini, mucosal glands, blood vessels, lymphatics, and goblet cells were also noted. Immunohistochemistry using CD3, CD20, CD138, and immunoglobulin A were used to substantiate the lymphoid tissues of the lacrimal sac.
A total of 200 lacrimal sacs were obtained from dacryocystectomy of 164 patients. The patients included 60.5% (99/164) females and 39.6% (65/164) males, with a mean age of 58.4 years at presentation. Laterality showed a predominance of left lacrimal sacs (55%, 110/200) as compared to the right lacrimal sacs (45%, 90/200). Symptoms of epiphora and discharge of more than 6 months duration were considered to be chronic. Lymphoid infiltrate pattern was diffuse in majority of the sacs (81%, 162/200), with subepithelial and intraepithelial together being the commonest location (46.5%, 93/200). Distinct lymphoid follicles were seen in 28% (56/200). Most of the sacs showed mild plasma cell infiltration (66.5%, 133/200). IgA-rich secretions were noted in the lumen and the lining epithelium in 34.5% (69/200). Other common changes noted include increase in the goblet cells (82%, 164/200), dilated lymphatics (94%, 188/200), proliferating blood vessels (99%, 198/200), thickened epithelium (54.5%, 109/200), and stromal fibrosis (88%, 176/200).
This study presents the largest series to date (n = 200 lacrimal sacs) exclusively on changes in lacrimal drainage-associated lymphoid tissue in human chronic dacryocystitis. This study could be the starting point for further exploration into the molecular biology, immunological implications, and possible implications of LDALT derangements on etiopathogenesis of primary acquired nasolacrimal duct obstruction.
研究人类慢性泪囊炎中泪囊相关淋巴组织的变化及其对原发性获得性鼻泪管阻塞的免疫防御机制和发病机制的可能影响。
回顾性介入研究，纳入 2009 年 7 月至 2012 年 7 月间连续就诊的 164 例患者的 200 个泪囊。收集的数据包括人口统计学资料、临床表现、侧别、就诊年龄、症状持续时间、诊断性冲洗、行泪囊切除术的指征、淋巴浸润的模式和严重程度、淋巴滤泡的类型及其位置、浆细胞和其他细胞浸润。还观察了与上皮、基质和管腔相关的变化，重点是腺泡、黏膜腺体、血管、淋巴管和杯状细胞。使用 CD3、CD20、CD138 和免疫球蛋白 A 进行免疫组织化学染色，以证实泪囊的淋巴组织。
共从 164 例患者的泪囊切除术获得 200 个泪囊。患者中女性占 60.5%（99/164），男性占 39.6%（65/164），就诊时的平均年龄为 58.4 岁。泪囊的侧别显示左侧（55%，110/200）明显多于右侧（45%，90/200）。流泪和溢液症状持续超过 6 个月被认为是慢性的。大多数泪囊中淋巴浸润呈弥漫性（81%，162/200），其中上皮下和上皮内浸润最常见（46.5%，93/200）。28%（56/200）的泪囊可见明显的淋巴滤泡。大多数泪囊有轻度浆细胞浸润（66.5%，133/200）。34.5%（69/200）的泪囊中可见富含 IgA 的分泌物。其他常见的变化包括杯状细胞增加（82%，164/200）、淋巴管扩张（94%，188/200）、血管增生（99%，198/200）、上皮增厚（54.5%，109/200）和基质纤维化（88%，176/200）。
本研究是迄今为止（n=200 个泪囊）专门研究人类慢性泪囊炎中泪囊相关淋巴组织变化的最大系列研究。本研究可能为进一步探索 LDALT 紊乱对原发性获得性鼻泪管阻塞的发病机制的分子生物学、免疫学意义以及可能的影响提供了起点。
