Mansour Hosam Othman, Elzaher Hassan Riad, Tharwat Ehab, Fekry Elgazzar Akram, Abd El-Salam Mohammed Eid, Ramadan Ezzeldin Ezzeldin, Hussein Mostafa Osman, Elmahdy Ahmed Gomaa
Ophthalmology Department, Al-Azhar University, Damietta Branch, New Damietta City, Egypt.
Ophthalmology Department, Al-Azhar University, Cairo, Egypt.
Med Hypothesis Discov Innov Ophthalmol. 2023 May 31;12(1):1-8. doi: 10.51329/mehdiophthal1464. eCollection 2023 Spring.
Nasolacrimal duct obstruction (NLDO) is characterized by epiphora and recurrent episodes of acute dacryocystitis. Despite the temporary effect of antibiotics in the acute phase, it is primarily managed by dacryocystorhinostomy (DCR). There is a new modification of external DCR that is performed without either anterior or posterior flaps. This study aimed to compare the outcomes of flapless and single-flap external DCR in adult patients with chronic symptomatic dacryocystitis secondary to NLDO.
In this retrospective, non-randomized, interventional, comparative study of patients with chronic dacryocystitis secondary to primary acquired NLDO, we compared the surgical outcomes and complication rates of flapless external DCR to those of external DCR with only anterior flap suturing. We excluded patients who declined participation and those with soft stops, nasal problems, lid margin abnormalities, lid malposition or laxity, previous lacrimal surgery, lacrimal fistula, trauma involving the lacrimal drainage system, lack of adequate follow-up, or severe septal deviation or turbinate hypertrophy. Anatomical and functional success rates were determined at the last follow-up visit and were compared. Postoperative complications were recorded and compared between groups.
We included 53 patients with a male-to-female ratio of 16 (30.2%) to 37 (69.8%); 25 eyes underwent flapless DCR (group 1) and 28 eyes underwent anterior flap suturing DCR (group 2). The two groups had comparable demographic characteristics (all > 0.05). Furthermore, anatomical (92.0% in group 1 and 92.9% in group 2) and functional (84.0% in group 1 and 92.9% in group 2) success rates at final follow-up were comparable between groups (both > 0.05). At the one-month postoperative examination, premature tube extrusion was more often reported in group 1 (12.0%) compared to group 2 (7.1%). At the two-month follow-up examination, tube extrusion was noted in 4.0% in group 1 and 0.0% in group 2, yet the difference failed to attain statistical significance ( > 0.05).
We found that neither surgical method was superior in terms of anatomical or functional success rate at a maximum of one year after external DCR. Flapless DCR is a simple, effective, and reproducible alternative to the single anterior flap suturing technique for managing NLDO in adults with chronic dacryocystitis. However, further randomized clinical trials with larger sample sizes and longer follow-up periods are recommended before generalization can be justified.
鼻泪管阻塞（NLDO）的特征为溢泪和急性泪囊炎反复发作。尽管抗生素在急性期有暂时疗效，但主要治疗方法是泪囊鼻腔吻合术（DCR）。有一种新型改良外路DCR，手术时无需制作前瓣或后瓣。本研究旨在比较无瓣和单瓣外路DCR治疗继发于NLDO的成人慢性症状性泪囊炎的效果。
在这项针对继发于原发性后天性NLDO的慢性泪囊炎患者的回顾性、非随机、干预性、对比研究中，我们比较了无瓣外路DCR与仅行前瓣缝合的外路DCR的手术效果和并发症发生率。我们排除了拒绝参与的患者以及存在软性阻塞、鼻腔问题、睑缘异常、睑位异常或松弛、既往泪道手术史、泪瘘、累及泪道引流系统的外伤、随访不充分、严重鼻中隔偏曲或鼻甲肥大的患者。在最后一次随访时确定解剖学和功能成功率并进行比较。记录术后并发症并在组间进行比较。
我们纳入了53例患者，男女比例为16例（30.2%）比37例（69.8%）；25只眼接受了无瓣DCR（第1组），28只眼接受了前瓣缝合DCR（第2组）。两组的人口统计学特征具有可比性（均P>0.05）。此外，末次随访时两组的解剖学成功率（第1组为92.0%，第2组为92.9%）和功能成功率（第1组为84.0%，第2组为92.9%）具有可比性（均P>0.05）。术后1个月检查时，第1组（12.0%）比第2组（7.1%）更常报告泪管过早脱出。在术后2个月随访检查时，第1组有4.0%出现泪管脱出，第2组为0.0%，但差异无统计学意义（P>0.05）。
我们发现，在外路DCR术后最长1年时，两种手术方法在解剖学或功能成功率方面均无优势。对于治疗患有慢性泪囊炎的成人NLDO，无瓣DCR是一种简单、有效且可重复的替代单前瓣缝合技术的方法。然而，在能够合理推广之前，建议进行样本量更大、随访期更长的进一步随机临床试验。
