Thomas R, Thomas S, Braganza A, Muliyil J
Schell Eye Hospital, Christian Medical College, Vellore, India.
Indian J Ophthalmol. 1997 Dec;45(4):211-4.
Patients for cataract surgery in India routinely undergo preoperative syringing to rule out chronic dacryocystitis. We determined the sensitivity and specificity of the clinical test of regurgitation on pressure over the lacrimal sac (ROPLAS) as a screening test for chronic dacryocystitis and compared it to syringing. 621 consecutive outpatients who needed syringing for various reasons (including 318 who had routine syringing prior to cataract surgery) were examined in a masked manner for regurgitation on pressure over the lacrimal sac. They then underwent syringing by a trained (masked) observer. The sensitivity and specificity of ROPLAS were 93.2% and 99.3%, respectively. Using a 6.6% prevalence of chronic dacryocystitis (the prevalence in our cataract population), the negative predictive value of the test was 99.5%. In the presence of regurgitation of pressure over the sac, the high specificity of ROPLAS confirms chronic dacryocystitis. In view of the opportunity costs, when ROPLAS is negative, preoperative syringing in cataract is perhaps unnecessary, unless the findings are equivocal or the index of suspicion for chronic dacryocystitis is very high.
在印度，白内障手术患者通常要接受术前泪道冲洗，以排除慢性泪囊炎。我们确定了泪囊加压反流临床检查（ROPLAS）作为慢性泪囊炎筛查试验的敏感性和特异性，并将其与泪道冲洗进行比较。对621例因各种原因需要进行泪道冲洗的连续门诊患者（包括318例白内障手术前常规泪道冲洗的患者）进行了盲法检查，以确定泪囊加压反流情况。然后由一名经过培训的（盲法）观察者为他们进行泪道冲洗。ROPLAS的敏感性和特异性分别为93.2%和99.3%。以慢性泪囊炎6.6%的患病率（我们白内障患者群体中的患病率）计算，该试验的阴性预测值为99.5%。当泪囊出现加压反流时，ROPLAS的高特异性可确诊慢性泪囊炎。鉴于机会成本，当ROPLAS结果为阴性时，白内障手术前的泪道冲洗可能没有必要，除非检查结果不明确或对慢性泪囊炎的怀疑指数非常高。
