Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye Institutes, University of California, Los Angeles, California.
Departments of Ocular Oncology and Oculoplastic Surgery, University of Cape Town, Cape Town, South Africa.
Ophthalmic Plast Reconstr Surg. 2020 Nov/Dec;36(6):549-552. doi: 10.1097/IOP.0000000000001629.
Lacrimal outflow imaging has been limited in clinical practice due to a combination of modality limitations and efficacy of clinical testing. Cone beam computed tomography dacryocystography (CBCT DCG) has certain advantages over other modalities that may enhance clinical utility. This study was intended to understand the relationships between symptoms, syringing and CBCT DCG in a population of patients presenting with tearing.
Cross-sectional cohort study of adult patients undergoing both CBCT DCG and clinical probing and irrigation. Concordance analysis between symptoms, clinical examination, and CBCT DCG was performed at baseline and postoperatively in patients who were treated with dacryocystorhinostomy.
CBCT DCG findings correlate fairly well with probing/irrigation (Cohen kappa = 0.376). Excluding cases of canalicular obstruction identified by either method, the correlation between CBCT DCG and probing/irrigation was moderately improved (Cohen kappa = 0.488). There was no statistically significant difference in correlation with patient symptoms between CBCT DCG and probing/irrigation (p = 0.877). Fifteen patients (17 lacrimal systems) patients underwent endoscopic dacryocystorhinostomy (DCR) surgery. Ten demonstrated absence of symptoms 90 days postoperatively, 3 endorsed continued tearing and 2 were lost to follow up. All 3 who demonstrated continued tearing, demonstrated canalicular obstruction on CBCT DCG which was not initially detected on probing/irrigation.
CBCT DCG correlates moderately well with probing and irrigation, as well as patient symptoms. This technology may assist in identification of functional/anatomic canalicular obstruction.
由于模态限制和临床测试效果的综合影响，泪液排出成像在临床实践中受到限制。锥形束 CT 泪道造影（CBCT DCG）在某些方面优于其他模式，可能会增强临床实用性。本研究旨在了解有流泪症状的患者中症状、冲洗和 CBCT DCG 之间的关系。
对接受 CBCT DCG 和临床探通及冲洗的成年患者进行横断面队列研究。对接受泪囊鼻腔吻合术治疗的患者进行术前和术后的症状、临床检查和 CBCT DCG 之间的一致性分析。
CBCT DCG 结果与探通/冲洗结果相关性较好（Cohen κ=0.376）。排除两种方法均确定的泪小管阻塞病例后，CBCT DCG 与探通/冲洗之间的相关性略有改善（Cohen κ=0.488）。CBCT DCG 与探通/冲洗之间与患者症状的相关性无统计学差异（p=0.877）。15 例（17 个泪道系统）患者接受了经内镜泪囊鼻腔吻合术（DCR）手术。术后 90 天 10 例患者无症状，3 例仍有流泪，2 例失访。所有 3 例仍有流泪的患者均在 CBCT DCG 上显示出泪小管阻塞，而在探通/冲洗时并未发现。
CBCT DCG 与探通和冲洗以及患者症状相关性较好。该技术可能有助于识别功能性/解剖性泪小管阻塞。
