Ganguly Anasua, Ramarao Kesarpu, Mohapatra Samir, Rath Suryasnata
Department of Ophthalmic Plastic and Reconstructive Surgery, Orbit and Ocular Oncology, L V Prasad Eye Institute, Bhubaneswar, Odisha, India.
Department of Anatomy, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Indian J Ophthalmol. 2016 Dec;64(12):893-897. doi: 10.4103/0301-4738.198855.
To report the anatomical and cosmetic outcome of transconjunctival dacryocystorhinostomy (TDCR) in an Asian Indian population.
TDCR was initially performed in cadaver eyes followed by patients with primary acquired nasolacrimal duct obstruction (NLDO). This was a prospective noncomparative case series of all consecutive TDCRs performed between April 2013 and June 2015. Outcome measures were anatomical patency, epiphora, presence of diplopia, aesthetic outcome, and health status.
A total of 17 (18 eyes) patients with a mean age 43.9 ± 11.8 years (range, 32-75) were included in the study. Eight were males, and one patient underwent TDCR in both eyes. TDCR was successfully performed in 15/18 (82%) eyes under local anesthesia. Procedure converted to transcutaneous external DCR in two and dacryocystectomy in one patient each. Mean duration of surgery was 52.6 (range, 29-110) min. Anatomical patency and relief from epiphora was achieved in all (15/15) eyes after TDCR at a median follow-up of 15.5 months. At final follow-up, objective assessment of the cosmetic outcome graded the surgical scar at the lateral canthus as invisible in all except one and conjunctival fornix as visible only after eyelid eversion in all patients. Disturbance of the medial fat pad was not seen in any patient. A questionnaire-based health status evaluation showed marked improvement in anxiety/depression before and after TDCR with an overall well-being score of 88 on a scale of 0-100 (worst-best) after TDCR.
TDCR offers a promising aesthetic approach in patients with primary acquired NLDO and gives excellent functional and cosmetic outcome.
报告经结膜泪囊鼻腔吻合术（TDCR）在亚洲印度人群中的解剖学和美容效果。
TDCR最初在尸体眼上进行，随后应用于原发性获得性鼻泪管阻塞（NLDO）患者。这是一项前瞻性非对照病例系列研究，纳入了2013年4月至2015年6月期间连续进行的所有TDCR手术。观察指标包括解剖学通畅情况、溢泪、复视情况、美容效果和健康状况。
本研究共纳入17例（18只眼）患者，平均年龄43.9±11.8岁（范围32 - 75岁）。其中8例为男性，1例患者双眼接受了TDCR手术。15/18（82%）只眼在局部麻醉下成功完成了TDCR手术。2例手术转为经皮肤外路泪囊鼻腔吻合术，1例患者进行了泪囊切除术。平均手术时间为52.6分钟（范围29 - 110分钟）。TDCR术后，在中位随访时间15.5个月时，所有（15/15）只眼均实现了解剖学通畅且溢泪症状缓解。在最终随访时，对美容效果的客观评估显示，除1例患者外，所有患者外眦部手术瘢痕均不可见，所有患者结膜穹窿部仅在眼睑翻转后可见。未发现任何患者内侧脂肪垫受到干扰。基于问卷的健康状况评估显示，TDCR前后焦虑/抑郁情况有显著改善，TDCR后总体幸福感评分为88分（0 - 100分，最差 - 最佳）。
TDCR为原发性获得性NLDO患者提供了一种有前景的美容手术方法，具有出色的功能和美容效果。
