The Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.
Division of Ophthalmology, Goldschleger Eye Institute, Sheba Medical Center, Sheba.
Ophthalmic Plast Reconstr Surg. 2023;39(6):579-582. doi: 10.1097/IOP.0000000000002406. Epub 2023 May 2.
Congenital Nasolacrimal duct obstruction (CNLDO) is a relatively common problem in children with Down syndrome (DS). Probing and irrigation (PI) with monocanalicular stent intubation may be less successful than in non-DS patients, thus raising some concerns regarding the preferred treatment in this population. We aimed to analyze the surgical outcome of PI along with monocanalicular stent intubation in children with DS compared with non-DS patients.
Retrospective cohort study. Thirty-five eyes of 19 children with DS and 1,472 eyes of 1,001 children without DS underwent PI-monocanalicular stent intubation as a primary treatment for CNLDO. All patients were operated on by a single surgeon at the Children's Hospital of Philadelphia between 2009 and 2020. The main outcome measure was a surgical success, defined as the resolution of symptoms after surgery.
A total of 1,020 patients were included, 48% females; mean age of 1.9 ± 1.4 years. The mean follow-up time was 35.0 months. The DS patients group consisted of 19 patients. Higher rates of right nasolacrimal duct obstruction and bilateral obstructions were observed in the DS group (100% vs. 73.2%; p = 0.006, and 84.2% vs. 46.8%; p = 0.001, respectively). Patients with DS had a lower success rate (57.1% vs. 92.4%; p < 0 .0001). The median time to failure was 3.1 months in the DS group, and 5.2 months in the group of patients without DS. The hazard ratio comparing DS to the no-DS outcome was 6.6 (95% CI: 3.2-13.7; p < 0.001).
CNLDO in DS is more likely to be bilateral and less likely to resolve after primary monocanalicular stent placement.
先天性鼻泪管阻塞（CNLDO）在唐氏综合征（DS）患儿中较为常见。与非 DS 患者相比，使用单通道探通联合支架植入术的效果可能较差，因此对于该人群的首选治疗方法存在一些担忧。我们旨在分析 DS 患儿与非 DS 患儿接受探通联合单通道支架植入术的手术效果。
回顾性队列研究。2009 年至 2020 年，在费城儿童医院，由同一位外科医生对 19 例患儿的 35 只眼和 1001 例患儿的 1472 只眼进行了 PI-单通道支架植入术作为 CNLDO 的一线治疗。主要观察指标为手术成功率，定义为手术后症状缓解。
共纳入 1020 例患者，女性占 48%；平均年龄 1.9±1.4 岁。平均随访时间为 35.0 个月。DS 患儿组包括 19 例患者。DS 组中右鼻泪管阻塞和双侧阻塞的发生率较高（100%比 73.2%，p=0.006 和 84.2%比 46.8%，p=0.001）。DS 患儿的成功率较低（57.1%比 92.4%，p<0.0001）。DS 组的中位失败时间为 3.1 个月，无 DS 组为 5.2 个月。DS 组与无 DS 组的风险比为 6.6（95%可信区间：3.2-13.7；p<0.001）。
DS 中的 CNLDO 更可能是双侧的，并且在初次单通道支架植入后不太可能缓解。
