Department of Ophthalmology, Guru Nanak Eye Centre (Associated with Maulana Azad Medical College), New Delhi, India.
Eye (Lond). 2023 Apr;37(6):1225-1230. doi: 10.1038/s41433-022-02104-4. Epub 2022 May 19.
To study the outcomes of transcanalicular laser dacryocystorhinostomy (TCL-DCR) with endonasal augmentation in acute versus post-acute dacryocystitis and compare it with external DCR in post-acute settings.
A prospective, randomised study was conducted in 90 adult cases of Acute dacryocystitis. All the patients were started on systemic antibiotics and a 4 mm × 4 mm osteotomy was created using TCL-DCR. The osteotomy was enlarged to 8 mm × 8 mm by endonasal augmentation at the same sitting in group 1, after 10 days in group 2 and after 10 days with external DCR in group 3. The cases were assessed for symptomatic relief and complications. Success was defined as functional and anatomical patency at 36 months.
The mean age was 45.33 ± 15.06 years and the male: female ratio was 1:2. The presenting complaints were painful swelling (100%), epiphora or discharge (88.8%), fistula (33%) and fever (6%). The average number of acute episodes was 2.96. The intra-group pain reduction from day 1 to day 4, was significant in all three groups (p = 0.000). Intra-operative (p = 0.015, χ = 8.37) and post-operative complications (p = 0.002, χ = 0.002) were higher in group. Anatomical success was achieved in all the three groups, however, the functional success in Group 3, Group 2 and Group 1 was 100%, 86.7% and 66.7% respectively (p = 0.002, χ = 12.86).
The creation of osteotomy using TCL-DCR provides early relief in symptoms. Single-stage surgery in inflamed tissues is associated with higher complication rates. External DCR in post-acute settings gives the best outcomes with minimal complications, endoscopic augmentation requires a close follow-up.
研究经鼻内窥镜下鼻腔泪囊吻合术（TCL-DCR）联合内眦成形术治疗急性和亚急性泪囊炎的效果，并与亚急性期的外路 DCR 进行比较。
前瞻性随机研究纳入 90 例急性泪囊炎成年患者。所有患者均接受全身抗生素治疗，并采用 TCL-DCR 行 4mm×4mm 骨切开术。第 1 组在同一时间通过经鼻内窥镜下鼻腔泪囊吻合术联合内眦成形术将骨切开术扩大至 8mm×8mm，第 2 组在第 10 天，第 3 组在第 10 天进行外路 DCR。评估症状缓解和并发症情况。36 个月时，功能和解剖通畅定义为成功。
平均年龄为 45.33±15.06 岁，男女比例为 1:2。主要表现为疼痛性肿胀（100%）、溢泪或溢脓（88.8%）、瘘管（33%）和发热（6%）。平均急性发作次数为 2.96 次。三组患者第 1 天至第 4 天的疼痛缓解程度均有显著差异（p=0.000）。术中（p=0.015，χ=8.37）和术后并发症（p=0.002，χ=0.002）发生率在第 1 组最高。三组均达到解剖成功，但第 3 组、第 2 组和第 1 组的功能成功率分别为 100%、86.7%和 66.7%（p=0.002，χ=12.86）。
TCL-DCR 行骨切开术可早期缓解症状。在炎症组织中单步手术与更高的并发症发生率相关。亚急性期外路 DCR 术后效果最佳，并发症最少，内镜下扩大术需要密切随访。
