Alturkistany W, Delmas J, Robert P-Y
Limoges University Hospital, 2, avenue Martin-Luther-King, 87000 Limoges, France; King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
Limoges University Hospital, 2, avenue Martin-Luther-King, 87000 Limoges, France.
J Fr Ophtalmol. 2020 Jun;43(6):494-499. doi: 10.1016/j.jfo.2019.09.015. Epub 2020 Mar 31.
To evaluate the applicability of anterior segment optical coherence tomography (AS-OCT) for objective diagnosis of punctal stenosis.
We report the use of AS-OCT in 3 cases of epiphora related to punctal stenosis. We followed the methodology described in previous studies. The examination was performed by a single technician using a single Spectralis OCT with the AS-OCT module. Three patients with complaints of epiphora (mean age=80 years) were examined. The external punctal diameter was measured on both infrared (IR) and OCT images. The internal diameter was measured on OCT images at a depth of 500μm. The diagnosis was confirmed by clinical examination.
The external punctal diameters were 159μm in the right eye (Cases 1 and 2) and 195μm in the left eye (case 2; mean: 171μm). All measurements were lower than cadaveric measurements (200-500μm), as well as previously described average diameters, thus confirming the diagnosis of punctal stenosis. The AS-OCT diameter correlated moderately with the punctal diameter estimate on the IR photos (mean: 183μm). In addition, the mean internal diameter of the punctum at 500μm (cases 1 and 2) was 58μm, which is consistent with the mean diameter at 500μm described in previous studies. Case 3 involved an 88-year-old man who complained of chronic epiphora. Slit lamp examination showed total punctal stenosis associated with cicatricial ectropion in the left eye due to a cutaneous tumor treated with radiotherapy. AS-OCT confirmed the presence of total punctual stenosis and the absence of associated canalicular stenosis.
Our study is obviously limited by its small study population. The decision to resort to surgery was made by 2 different surgeons. There was thus no homogeneity in terms of stenosis. There is difficulty in everting the lid without applying pressure to the globe or changing the punctal or canalicular morphology. This maneuver was difficult in the postoperative setting after ectropion repair.
Our study shows that AS-OCT can be a rapid, non-invasive method in diagnosing punctal stenosis. Further studies are necessary to assess the use of AS-OCT in punctal stenosis.
评估眼前节光学相干断层扫描（AS-OCT）在泪点狭窄客观诊断中的适用性。
我们报告了AS-OCT在3例与泪点狭窄相关的溢泪病例中的应用。我们遵循了先前研究中描述的方法。检查由一名技术人员使用配备AS-OCT模块的单一Spectralis OCT进行。对3例主诉溢泪的患者（平均年龄 = 80岁）进行了检查。在红外（IR）图像和OCT图像上测量外泪点直径。在OCT图像上500μm深度处测量内直径。通过临床检查确诊。
右眼（病例1和2）的外泪点直径为159μm，左眼（病例2）为195μm（平均：171μm）。所有测量值均低于尸体测量值（200 - 500μm）以及先前描述的平均直径，从而证实了泪点狭窄的诊断。AS-OCT直径与IR照片上泪点直径估计值呈中度相关（平均：183μm）。此外，病例1和2中泪点在500μm处的平均内直径为58μm，这与先前研究中描述的500μm处的平均直径一致。病例3为一名88岁男性，主诉慢性溢泪。裂隙灯检查显示左眼因放疗治疗的皮肤肿瘤导致完全性泪点狭窄并伴有瘢痕性睑外翻，并伴有泪小管狭窄。AS-OCT证实存在完全性泪点狭窄且无相关泪小管狭窄。
我们的研究显然受到研究人群规模小的限制。手术决策由2名不同的外科医生做出。因此在狭窄方面缺乏同质性。在不向眼球施加压力或不改变泪点或泪小管形态的情况下翻开眼睑存在困难。在睑外翻修复术后的情况下，这种操作很困难。
我们的研究表明，AS-OCT可以是一种快速、非侵入性的泪点狭窄诊断方法。有必要进行进一步研究以评估AS-OCT在泪点狭窄中的应用。
