Ophthalmology department, Metz-Thionville regional hospital center, Mercy hospital, 1, allée du Château, CS 45001, Metz cedex 03, France.
Ophthalmology department, Metz-Thionville regional hospital center, Mercy hospital, 1, allée du Château, CS 45001, Metz cedex 03, France.
J Fr Ophtalmol. 2021 Mar;44(3):397-403. doi: 10.1016/j.jfo.2020.05.024. Epub 2020 Dec 30.
Endonasal dacryocystorhinostomy (DCR) is a surgical procedure that aims to increase tear drainage to treat epiphora caused by nasolacrimal obstruction by creating a bypass through the bone between the lacrimal sac and the nasal cavity. A silicone stent is temporarily put in place for 2 months to avoid early obstruction of the rhinostomy. One of the causes of surgical failure is related to progressive stenosis of intranasal ostium, due to fibrosis and new bone growth, inducing a relapse of epiphora and/or dacryocystitis. Few studies have described changes in the size of the intranasal ostium on direct post-DCR measurement or kinetics of its shrinkage. The purpose of this study is to determine whether changes in the size of intranasal ostium might be a predictor of final functional efficacy.
A prospective cohort of eighteen consecutive patients undergoing endonasal DCR for chronic epiphora or chronic dacryocystitis between January 2017 and April 2018 was analyzed. Eight patients who underwent bilateral DCR, and twenty-six intranasal ostia were finally analyzed. Follow-up took place every two months for 1 year, with the silicone tube removed at 2 months. Functional success was defined as absence of recurrent epiphora or dacryocystitis. Ostium size was systematically measured on photos taken during intranasal endoscopy performed every 2 months for 1 year.
At 2 months after endonasal DCR, 23 of the 26 ostia (88.5%) were functional, but only 19 (73.1%) of them were directly measurable. The mean horizontal diameter at 2 months was 1.44 (SD 0.61) mm, and the mean vertical diameter was 0.86 (SD 0.37) mm, which corresponded to a mean area of 10 (SD 0.84)mm. We noted a statistically significant decrease in ostium size and area between 2 and 4 months after the procedure (P -0.001), followed by a stabilization period with no statistical correlation between the size of the ostium and its final functional efficacy. At 6 months after DCR, of the 7 ostia that were not initially measurable, 3 were immediately non-functional at 2 months, 3 had a relapse of epiphora at 4 months, and 1 had a relapse of dacryocystitis at 6 months, i.e., 100% clinical failures at 6 months. The other procedures all remained functional after 1 year of follow-up.
The intranasal ostium of an endonasal DCR shrinks significantly within the 2 months after removal of the silicone tube and remains stable thereafter. There is no correlation between the size or area of intranasal ostium and its final functional efficacy. However, when the ostium is not measurable at the time of 2-month stent removal, all patients experienced a relapse of epiphora or dacryocystitis within 6 months.
经鼻内泪囊鼻腔吻合术（DCR）是一种旨在增加泪液引流的手术，通过在泪囊和鼻腔之间的骨头上创建一个旁路来治疗因鼻泪管阻塞引起的溢泪。手术后会暂时放置一个硅胶支架 2 个月，以避免吻合口早期阻塞。手术失败的原因之一与鼻内造口的进行性狭窄有关，这是由于纤维化和新骨生长导致的，会导致溢泪和/或泪囊炎复发。很少有研究描述过直接在 DCR 后测量或测量其收缩时鼻内造口大小的变化。本研究的目的是确定鼻内造口大小的变化是否可以作为最终功能疗效的预测指标。
对 2017 年 1 月至 2018 年 4 月期间因慢性溢泪或慢性泪囊炎而行经鼻内 DCR 的 18 例连续患者进行了前瞻性队列研究。有 8 例患者行双侧 DCR，共分析了 26 个鼻内造口。随访时间为 1 年，每 2 个月进行一次，硅胶管在 2 个月时取出。功能成功定义为无复发性溢泪或泪囊炎。在术后 2 个月内，通过每 2 个月进行一次的鼻内内窥镜检查拍摄照片，系统地测量鼻内造口的大小。
DCR 后 2 个月，26 个造口中有 23 个（88.5%）是功能性的，但只有 19 个（73.1%）是可直接测量的。2 个月时的平均水平直径为 1.44（SD 0.61）mm，垂直直径为 0.86（SD 0.37）mm，平均面积为 10（SD 0.84）mm。我们注意到，术后 2 至 4 个月间，造口大小和面积有明显减小（P-0.001），之后进入稳定期，造口大小与最终功能疗效之间无统计学相关性。DCR 后 6 个月时，7 个最初无法测量的造口，其中 3 个在 2 个月时立即失去功能，3 个在 4 个月时出现溢泪复发，1 个在 6 个月时出现泪囊炎复发，即 6 个月时临床失败率为 100%。其余手术在 1 年的随访后均保持功能。
经鼻内 DCR 后，鼻内造口在硅胶管取出后 2 个月内显著缩小，此后保持稳定。鼻内造口的大小或面积与其最终功能疗效之间无相关性。然而，当支架取出后 2 个月时造口无法测量时，所有患者在 6 个月内均出现溢泪或泪囊炎复发。
