Pokorná J, Brunnerová R, Krásný J
Cesk Slov Oftalmol. 2013 Dec;69(6):239-42.
The authors evaluated the successfulness of the conservative and intervention therapies combination in inborn lacrimal drainage system obstruction in a study group of 728 infants with 1154 eyes involved, treated at the Department of Ophthalmology, Faculty Hospital Královské Vinohrady (Kings Vineyards), Charles University, Prague, Czech Republic, E.U., during the period May 2004 - January 2011. The Fluoresceine Dye Dilution Test (FDDT) was used as the basic diagnostic test for the choice of the treatment procedure. The conservative therapy by itself, consisting of hydrostatic massages and application of germicide drops was helpful to canalize the lacrimal drainage system in 20 % of treated eyes, mostly in patients up to two months of age. The most of the patients (980 involved eyes), reached the Children outpatients of the Department of Ophthalmology at the age of approximately three months (average, 2.8 months). Since this age, the combination of the therapeutic irrigation with the probing, followed by the hydrostatic massages was indicated. The authors modified the probing technique according to their own experience gained during the endonasal intubation of the lacrimal drainage system by means of silicone tubing. At the phase of Bowmans probe entering the nasolacrimal sac, the probe was turned under the angle of 45 degrees to the vertical axis of the nose with simultaneous pressuring the probe against the orbital margin. By this procedure, the probe was introduced into the medial nasal meatus in the region of maxillary uncinate processus. Up to the end of the sixth month of age of the followed up infants, using the combination of conservative and intervention procedures, the lacrimal drainage system of 1036 eyes (90 %) was canalized. Out of 118 eyes with stenosis remaining even after 6 months of age, using the above-mentioned conservative therapy until the age of one year, 96 lacrimal drainage systems were further canalized. In the remaining 22 eyes (2 %) after the age of 1 year, the intubation of the lacrimal drainage system using the silicone tubing was performed. The total successfulness of our conservative intervention treatment strategy of lacrimal drainage system inborn obstruction up to the age of one year was 98 %.
作者评估了保守治疗与干预治疗相结合对先天性泪道系统阻塞的疗效。研究组为捷克共和国布拉格查理大学医学院附属克拉洛夫斯基·维诺赫拉迪医院（国王葡萄园医院）眼科在2004年5月至2011年1月期间治疗的728例婴儿，共1154只眼睛。荧光素染料稀释试验（FDDT）作为选择治疗方法的基本诊断试验。单纯的保守治疗，包括泪囊按摩和应用抗菌滴眼液，使20%的患眼泪道系统通畅，主要是两个月龄以内的患儿。大多数患者（980只患眼）在大约三个月龄（平均2.8个月）时到眼科儿童门诊就诊。自此年龄起，建议采用治疗性冲洗与探通术相结合，随后进行泪囊按摩。作者根据经硅胶管泪道系统鼻内插管获得的自身经验改进了探通技术。在Bowman探针进入鼻泪囊阶段，将探针向鼻垂直轴呈45度角转动，同时将探针向眶缘施压。通过该操作，将探针插入上颌钩突区域的中鼻道。在随访婴儿六个月龄结束时，采用保守治疗与干预治疗相结合的方法，1036只眼睛（90%）的泪道系统通畅。在6个月龄后仍有狭窄的118只眼睛中，采用上述保守治疗至一岁，96个泪道系统进一步通畅。在一岁后仍有22只眼睛（2%），采用硅胶管进行泪道系统插管。我们对一岁以内先天性泪道阻塞的保守干预治疗策略的总成功率为98%。
