Departments of *Ophthalmology and Visual Sciences, and †Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A.
Ophthalmic Plast Reconstr Surg. 2014 Mar-Apr;30(2):152-6. doi: 10.1097/IOP.0000000000000034.
Etiologies of lacrimal obstruction requiring a dacryocystorhinostomy (DCR) have been reviewed previously but most commonly are thought to result from "primary acquired" nasolacrimal duct obstruction, a process of chronic inflammation in a narrowed duct. The authors have observed that secondary causes are frequently associated with bilateral lacrimal outflow disease. The purpose of this study is to investigate this relationship to help the clinician prioritize which patients to evaluate for secondary causes.
This is a retrospective case-controlled review of patients who underwent bilateral DCR from 1986 to 2012 at this institution. They are compared with an age and gender-matched control group who underwent unilateral DCR. Statistical analysis was undertaken using the Pearson chi-square test for p value, except for age, which used the Wilcoxon rank sum test. Logistic regression was used for comparing prevalence of secondary issues in bilateral disease versus unilateral disease, with age as covariate.
Two hundred thirty-five patients underwent bilateral (91) or unilateral DCR (144). Twice as many patients undergoing bilateral DCR had an underlying secondary cause compared with the patients undergoing unilateral DCR. (38%, 19%, p= 0.001, odds ratio 2.59). In patients <50, the odds ratio of a secondary cause in bilateral disease would be 5.34 compared with patients older than 80. (p = 0.0002) Patients in the bilateral DCR group underwent revisions at more than twice the rate as patients in the unilateral DCR group (26%, 12%, p = 0.007).
Ophthalmologists should have a high index of suspicion for secondary conditions underlying bilateral lacrimal outflow obstruction, especially in patients <50. These patients should undergo laboratory workup and intraoperative biopsy. They should also be counseled regarding a higher failure rate.
先前已经回顾了需要行泪囊鼻腔吻合术（DCR）的泪道阻塞的病因，但最常见的病因被认为是“原发性获得性”鼻泪管阻塞，这是一个狭窄的鼻泪管发生慢性炎症的过程。作者观察到，继发性病因常与双侧泪液流出道疾病相关。本研究旨在研究这种关系，以帮助临床医生确定需要评估继发性病因的患者。
这是对 1986 年至 2012 年期间在本机构接受双侧 DCR 的患者进行的回顾性病例对照研究。他们与接受单侧 DCR 的年龄和性别匹配的对照组进行比较。使用 Pearson 卡方检验进行 p 值的统计分析，除年龄外，使用 Wilcoxon 秩和检验。使用逻辑回归比较双侧疾病与单侧疾病中继发性问题的患病率，年龄为协变量。
235 例患者接受了双侧（91 例）或单侧 DCR（144 例）。与接受单侧 DCR 的患者相比，行双侧 DCR 的患者中有两倍多的患者存在潜在的继发性病因。（38%，19%，p=0.001，优势比 2.59）。在<50 岁的患者中，双侧疾病继发性病因的比值比为 5.34，而大于 80 岁的患者为 0.0002。（p=0.0002）双侧 DCR 组的患者需要再次手术的比例是单侧 DCR 组的两倍以上（26%，12%，p=0.007）。
眼科医生应该对双侧泪液流出道阻塞的潜在继发性疾病保持高度怀疑，特别是在<50 岁的患者中。这些患者应进行实验室检查和术中活检。他们还应被告知更高的失败率。
