Yang Min Kyu, Kim Namju, Choung Ho-Kyung, In Khwarg Sang
Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumiro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea.
Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, 03080, South Korea.
Graefes Arch Clin Exp Ophthalmol. 2019 Oct;257(10):2315-2322. doi: 10.1007/s00417-019-04392-1. Epub 2019 Jul 24.
To evaluate the effect of a topical steroid instillation on recently developed incomplete nasolacrimal duct obstruction (NLDO) evaluated by using anterior segment optical coherence tomography (ASOCT).
Forty-nine eyes of 31 patients with incomplete NLDO who developed epiphora within 3 months were recruited and treated with a topical steroid for 3 months. Tear meniscus height (TMH) and area (TMA) were measured by ASOCT. The treatment was considered to be effective when there was improvement of subjective epiphora, normal tear meniscus on slit lamp examination, a fluorescein dye disappearance test with grade 0 or 1, and TMH < 250 μm on ASOCT. The treatment effectiveness and associated factors were analyzed.
Treatment was effective in 24 eyes (49.0%) after 6 months of follow-up. TMH and TMA at 3 months were significantly decreased in the effective group on ASOCT (TMH: from 385 to 268 μm, p = 0.002, TMA: from 0.0564 to 0.0266 mm, p = 0.001, Wilcoxon test). In the effective group, the eyes with normal tear meniscus at 1 month were significantly more frequent than those in the ineffective group (p < 0.001, Fisher's exact test). No patient in the effective group required further invasive management during 3 years of follow-up.
Topical steroid instillation has a significant therapeutic effect on recently developed incomplete NLDO. Additional invasive procedures were avoided in half of the subjects.
通过前段光学相干断层扫描（ASOCT）评估局部应用类固醇滴眼液对近期发生的不完全性鼻泪管阻塞（NLDO）的疗效。
招募31例不完全性NLDO且在3个月内出现溢泪症状的患者的49只眼，局部应用类固醇滴眼液治疗3个月。通过ASOCT测量泪液半月皱襞高度（TMH）和面积（TMA）。当主观溢泪症状改善、裂隙灯检查显示泪液半月皱襞正常、荧光素钠消失试验为0级或1级且ASOCT测量的TMH<250μm时，认为治疗有效。分析治疗效果及相关因素。
随访6个月后，24只眼（49.0%）治疗有效。有效组在ASOCT上3个月时的TMH和TMA显著降低（TMH：从385μm降至268μm，p = 0.002；TMA：从0.0564mm²降至0.0266mm²，p = 0.001，Wilcoxon检验）。有效组中1个月时泪液半月皱襞正常的眼比无效组更常见（p < 0.001，Fisher精确检验）。有效组在3年随访期间无患者需要进一步的侵入性治疗。
局部应用类固醇滴眼液对近期发生的不完全性NLDO有显著治疗效果。半数受试者避免了额外的侵入性手术。
