Goel Ruchi, Nagpal Smriti, Kumar Sushil, Meher Ravi, Kamal Saurabh, Garg Sonam
*Department of Ophthalmology, Guru Nanak Eye Centre (Associated with Maulana Azad Medical College), Maharaja Ranjeet Singh Marg; and †Department of Otolaryngorhinology, Lok Nayak Hospital (Associated with Maulana Azad Medical College), Jawahar Lal Nehru Marg, New Delhi, India.
Ophthalmic Plast Reconstr Surg. 2017 Nov/Dec;33(6):408-412. doi: 10.1097/IOP.0000000000000802.
To evaluate and compare the success rate of transcanalicular laser-assisted dacryocystorhinostomy with endonasal augmentation, with and without intubation, in patients suffering from primary acquired nasolacrimal duct obstruction, at 1 year of follow up.
A prospective, randomized interventional pilot study was conducted at a tertiary care center, in accordance with the guidelines of Declaration of Helsinki. Sixty eyes of 60 adult patients with primary acquired nasolacrimal duct obstruction were included. The participants were divided randomly into 2 equal groups (A and B-without and with bicanalicular intubation, respectively). An osteotomy was first created using 980 nm diode laser (set at 8W continuous mode) transcanalicularly and then enlarged intranasally using Blakesley's nasal forceps, followed by bicanalicular silicon intubation in group B patients. The tubes were removed at the end of 8 weeks. The ostium size was assessed endoscopically at 8 weeks and again at the end of follow up, at 1 year. A successful outcome was defined in terms of ostium patency at the end of 1 year. The results were analyzed at the end of a follow up of 1 year, using various statistical tests (p < 0.05).
The mean age of the patients was 35.3 ± 15.89 years, with 23 male and 37 female patients, the 2 groups having a similar male:female ratio. An overall success rate of 90% was achieved at the end of 1 year with no statistically significant difference between the groups. Postoperative complications like tube displacement and punctal, canalicular injury were more in the intubated group. The average osteotomy size was 8.06 ± 5.4 mm at the end of 1 year.
Transcanalicular laser-assisted dacryocysto rhinostomy, with endonasal augmentation, is a scarless, effective, daycare procedure, for treatment of primary acquired nasolacrimal duct obstruction with no additional advantage offered by silicone intubation.
评估并比较经泪小管激光辅助泪囊鼻腔造口术联合鼻内扩大术在有或无插管情况下，对原发性后天性鼻泪管阻塞患者进行1年随访时的成功率。
在一家三级医疗中心按照《赫尔辛基宣言》的指导方针进行了一项前瞻性、随机干预性试点研究。纳入60例患有原发性后天性鼻泪管阻塞的成年患者的60只眼睛。参与者被随机分为两组（A组和B组，分别为无泪小管插管组和有泪小管插管组）。首先使用980纳米二极管激光（设置为8瓦连续模式）经泪小管进行截骨，然后使用布莱克斯利鼻钳在鼻内扩大，B组患者随后进行泪小管硅胶插管。8周结束时取出导管管。在8周时通过内镜评估造口大小，并在随访结束时（1年时）再次评估。成功的结果定义为1年结束时造口通畅。在1年的随访结束时，使用各种统计检验分析结果（p<0.05）。
患者的平均年龄为35.3±15.89岁，男性23例，女性37例，两组的男女比例相似。1年结束时总体成功率达到90%，两组之间无统计学显著差异。插管组术后并发症如导管移位以及泪点、泪小管损伤更多。1年结束时平均截骨大小为8.06±5.4毫米。
经泪小管激光辅助泪囊鼻腔造口术联合鼻内扩大术是一种无瘢痕、有效的日间手术，用于治疗原发性后天性鼻泪管阻塞，硅胶插管并无额外优势。
