Randomized Controlled Trial on Silicone Intubation in Endoscopic Mechanical Dacryocystorhinostomy (SEND): An 11-year Outcome Report.

IF 1.9 4区医学 Q2 OPHTHALMOLOGY

Seminars in Ophthalmology Pub Date : 2024-09-08 DOI:10.1080/08820538.2024.2385391

Karen Kar-Wun Chan, Grace Wing Yung, Arnold Shau Hei Chee, Joyce Kar Yee Chin, Tiffany Ho Ling Ong, Angela On Ying Yiu, Thomas Chun Hei Lo, Yuzhou Zhang, Frank Hiu Ping Lai, Wilson Wai Kuen Yip, Alvin Lerrmann Young, Hunter Kwok Lai Yuen, Mohammad Javed Ali, Kelvin Kam Lung Chong

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引用次数: 0

Abstract

Purpose: To compare the long-term outcomes of mucosal-sparing mechanical endoscopic dacryocystorhinostomy (MMED) for primary acquired nasolacrimal duct obstruction (PANDO) with or without silicone intubation.

Methods: An 11-year follow-up study of the Silicone intubation in Endoscopic Dacryocystorhinostomy (SEND) randomized controlled trial (RCT) was conducted at a university-affiliated dacryology clinic from December 2019 to March 2023. Questionnaires on symptoms, anterior segment examination, endoscopic examination with functional endoscopic dye test (FEDT) and FICI grading, and ostial size measurements using Image J software were performed by a masked ophthalmologist. The primary outcome was surgical success, defined by Munk's score ≤1 and a positive fluorescein endoscopic dye test. Secondary outcomes included risk factors for failure and outcomes of revision surgeries.

Results: Fifty-three of the original 118 patients were evaluated at 155 ± 21 (136-218) months postoperatively. Seventy-seven percent (46/60) ostia remained successful, including 70% (19/27) of unstented and 82% (27/33) of stented ostia (p = .3). Stented ostia had larger size (p = .003), but this did not confer higher success (p = .14). Successful ostia had higher FICI scores and better ostial dynamicity (p < .05). Ostium movement was the only parameter associated with surgical success on multivariate analysis (OR 13.1, p = .01). Four (1 stented) underwent revision MMED, intraoperative mitomycin-C, and 12-week intubation. All revision ostia were functional after 141 ± 43 months.

Conclusions: Surgical success of MMED after 11-years was 77%, a notable reduction compared to 96% success at 1-year. Statistical advantage of silicone intubation for primary MMED was not demonstrated, though clinically, stented ostia had a higher success (82% vs 70%). The presence of a dynamic internal common opening was highly associated with long-term surgical success.

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内镜下机械性泪囊鼻腔造口术（SEND）中硅胶插管的随机对照试验：11 年结果报告。

目的：比较对原发性获得性鼻泪管阻塞（PANDO）进行粘膜保留机械内镜下泪囊鼻腔吻合术（MMED）时是否进行硅胶插管的长期疗效：2019年12月至2023年3月，在一所大学附属的泪腺门诊开展了一项为期11年的内镜下泪囊鼻腔吻合术中硅胶插管随机对照试验（RCT）的随访研究。由一名蒙面眼科医生进行症状问卷调查、前节检查、功能性内窥镜染色试验（FEDT）和FICI分级的内窥镜检查，以及使用Image J软件进行的骨孔大小测量。主要结果是手术成功，其定义是蒙克评分≤1和荧光素内窥镜染色试验阳性。次要结果包括失败的风险因素和翻修手术的结果：在最初的 118 名患者中，有 53 名患者在术后 155 ± 21 (136-218) 个月时接受了评估。77%（46/60）的造口仍然成功，包括70%（19/27）的未支架造口和82%（27/33）的支架造口（p = .3）。支架造口的尺寸更大（p = .003），但这并不意味着成功率更高（p = .14）。成功的支架具有更高的 FICI 评分和更好的支架动态性（p 结论：MMED 的手术成功率并不高：11 年后，MMED 的手术成功率为 77%，与 1 年时 96% 的成功率相比明显下降。尽管在临床上，支架造口的成功率更高（82% 对 70%），但硅胶插管用于初级 MMED 的统计优势并未得到证实。动态内部共同开口的存在与长期手术成功率高度相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Seminars in Ophthalmology OPHTHALMOLOGY-

CiteScore

3.20

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Seminars in Ophthalmology offers current, clinically oriented reviews on the diagnosis and treatment of ophthalmic disorders. Each issue focuses on a single topic, with a primary emphasis on appropriate surgical techniques.