Singh Manpreet, Gautam Natasha, Ahir Nitasha, Kaur Manpreet
Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India.
Department of Ophthalmology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India.
Indian J Ophthalmol. 2017 Nov;65(11):1114-1119. doi: 10.4103/ijo.IJO_499_17.
The aim is to analyze the influence of the location of lacrimal canalicular laceration over the eventual anatomical and functional success after surgery.
Retrospective, observational study of proximal canalicular laceration (PCL) and distal canalicular laceration (DCL) repairs by a single surgeon (MS). The distance between lacrimal punctum and the lateral canalicular lacerated end was defined as proximal (<6 mm) and distal (≥6 mm). The operation theater setup, microscopic magnified view, local adrenaline, and pigtail probe were used to locate the medial canalicular lacerated end. All patients underwent lacrimal stenting and the stents were removed after 3 months (12th week visit). After stent removal, a fluorescein dye disappearance test and lacrimal irrigation were performed to assess the anatomical and functional success of the operation.
Of 36 canalicular lacerations, 30 (83.33%) were monocanalicular lacerations which were repaired using monocanalicular stents. Of 6 (16.67%) bicanalicular lacerations, three were repaired using bicanalicular stents while in the remaining three, one monocanalicular stent was placed in each lacerated canaliculi. The medial cut end was identified by magnified visualization in 27 (75%), with adjunctive local adrenaline in four (11.11%) and pigtail probe in five (13.89%) patients. The mean post stent removal follow-up was 44 weeks. The DCL (n = 24, 66.67%) showed better functional and complete success as compared to PCL (75% vs. 33.33%, P = 0.03). Eight (22.22%) had spontaneous stent extrusion, two (5.56%) had loop prolapse, four (11.11%) had punctum granuloma, and three (8.33%) had medial canthus dystopia.
The location of canalicular laceration may help to prognosticate the functional and qualified success rate. We experienced better-qualified success in the distal canalicular laceration group.
分析泪小管撕裂部位对手术最终解剖和功能成功的影响。
对由单一外科医生（MS）进行的近端泪小管撕裂（PCL）和远端泪小管撕裂（DCL）修复进行回顾性观察研究。泪点与外侧泪小管撕裂端之间的距离定义为近端（<6mm）和远端（≥6mm）。使用手术室设置、显微镜放大视野、局部肾上腺素和猪尾探针来定位内侧泪小管撕裂端。所有患者均接受泪道支架置入，3个月后（第12周复诊时）取出支架。取出支架后，进行荧光素染料消失试验和泪道冲洗，以评估手术的解剖和功能成功情况。
在36例泪小管撕裂中，30例（83.33%）为单泪小管撕裂，采用单泪小管支架修复。在6例（16.67%）双泪小管撕裂中，3例采用双泪小管支架修复，其余3例中，每个撕裂的泪小管置入1个单泪小管支架。通过放大可视化在27例（75%）患者中识别出内侧切断端，4例（11.11%）患者使用辅助局部肾上腺素，5例（13.89%）患者使用猪尾探针。支架取出后的平均随访时间为44周。与PCL相比，DCL（n = 24，66.67%）显示出更好的功能和完全成功率（75%对33.33%，P = 0.03）。8例（22.22%）出现支架自发脱出，2例（5.56%）出现袢脱垂，4例（11.11%）出现泪点肉芽肿，3例（8.33%）出现内眦移位。
泪小管撕裂的部位可能有助于预测功能和合格成功率。我们在远端泪小管撕裂组中获得了更好的合格成功率。
