1] Department of Ophthalmology, Tongji Hospital affiliated with Tongji University School of Medicine, Shanghai, China [2] Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.
Eye (Lond). 2013 Nov;27(11):1275-80. doi: 10.1038/eye.2013.169. Epub 2013 Aug 23.
To evaluate the efficacy of two-step retrograde closed stenting for treating canalicular laceration. methods: Forty-eight consecutive canalicular laceration cases (48 eyes) were randomised and divided into two groups: a one-step group and a two-step group. In the two-step group (23 cases), the first step was performed in the outpatient department and included identifying the medial cut end of the canaliculus and probing under a slit-lamp microscope, followed by a retrograde canalicular stenting assisted by a memory titanium stylet. The second step was canalicular anastomosis, which was performed in the operating room. In the one-step group (25 cases), all of the surgical procedures were performed when preoperative preparations were simultaneously available.
The time elapsed from the doctor visit to the treatment was 4.3 ± 2.4 h in the two-step group and 18.8 ± 6.3 h in the one-step group (P<0.01). The canalicular medial cut ends were found in all cases, but 8.6 ± 3.5 min was needed in the two-step group, and 51.4 ± 24.2 min was needed in the one-step group (P<0.01). The numerical rating scale for pain during surgery was 1.8 ± 1.2 in the two-step group and 5.4 ± 2.2 in the one-step group (P<0.01). One case (2.63%) in the two-step group and nine cases (36%) in the one-step group required other assisted methods to locate the medial cut end (P=0.007). Twenty-one cases (91.3%) in the two-step group and 20 cases (80%) in the one-step group achieved patent lacrimal drainage systems during a 12-month follow-up (P=0.528).
The two-step canalicular anastomosis method allows an early search for the medial cut end of the canaliculus and improves the chances of finding it; it is also a quicker, less invasive method for treating canalicular lacerations.
评估两步逆行封闭置管治疗泪小管断裂的疗效。
连续 48 例（48 眼）泪小管断裂患者随机分为两组：一步法组和两步法组。在两步法组（23 例）中，第一步在门诊进行，包括在裂隙灯显微镜下识别泪小管的内侧断端，并进行逆行泪小管置管，然后用记忆钛丝引导。第二步是在手术室进行泪小管吻合术。在一步法组（25 例）中，所有手术均在术前准备同时进行。
两步法组从就诊到治疗的时间为 4.3±2.4 h，一步法组为 18.8±6.3 h（P<0.01）。所有病例均找到泪小管内侧断端，但两步法组需要 8.6±3.5 min，一步法组需要 51.4±24.2 min（P<0.01）。两步法组手术疼痛的数字评分量表为 1.8±1.2，一步法组为 5.4±2.2（P<0.01）。两步法组 1 例（2.63%）和一步法组 9 例（36%）需要其他辅助方法定位内侧断端（P=0.007）。两步法组 21 例（91.3%）和一步法组 20 例（80%）在 12 个月随访时泪道通畅（P=0.528）。
两步法泪小管吻合术可早期寻找泪小管内侧断端，提高寻找到的机会；也是治疗泪小管断裂更快、创伤更小的方法。
