神经剥夺性干眼症患者泪腺神经化的鞍神经垂直交叉面移植术的长期疗效。

IF 2.4 3区 医学 Q2 OPHTHALMOLOGY
Alfonso Strianese, Federico Bolognesi, Giuseppe Giannaccare, Valentino de Ruvo, Fabiana Allevi, Filippo Tarabbia, Luca Mario Rossetti, Federico Biglioli, Paolo Fogagnolo
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引用次数: 0

摘要

目的:我们最近描述了一种新型手术方法,用于重新支配神经性干眼症患者的泪腺,并报告了相应治疗患者的 1 年疗效。本文旨在描述这种创新手术技术的长期疗效:单中心横断面研究,包括受面瘫影响且泪液分泌绝对不足(Schirmer 试验 0 毫米/5 分钟)的连续患者,他们都接受了泪腺神经化手术,如前所述。在手术前(T0)和最后一次随访时(T1),对以下参数进行了评估:泪膜破裂时间(TBUT)、角膜荧光素染色(牛津评分)、Schirmer 测试 I 型、泪液替代物的使用(每日灌注次数)。在 T1 阶段,收集对手术的主观满意度,并测量手术眼和对侧眼的泪膜渗透压(TFO)。由于同时存在神经营养性角膜病(三叉神经麻痹)而接受泪腺和角膜神经化手术的患者,在T0和T1进行了角膜敏感度测定:分析了 9 名接受泪腺神经化手术的患者(4 名男性,5 名女性;平均年龄为 47.1 ± 17.1 岁)的数据,这些患者的平均随访时间为 87 个月(± 15)(范围为 60-108 个月)。所有病例的研究过程都与面部复位术相结合,4 例病例进行了角膜神经术。在 T1 阶段,Schirmer 试验的平均值明显高于 T0 阶段(5.8 ± 2.0 vs 0 ± 0 mm/5 min; p 结论:在 T0 阶段,Schirmer 试验的平均值明显高于 T0 阶段(5.8 ± 2.0 vs 0 ± 0 mm/5 min; p通过鞍神经进行泪腺神经术是一种安全有效的手术,长期疗效稳定良好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-term outcomes of sural nerve vertical cross-face graft for lacrimal gland neurotization in neurodeprivative dry eye.

Purpose: We recently described a novel surgical procedure to reinnervate the lacrimal gland in neurodeprivative dry eye disease and reported the 1-year outcomes of patients treated accordingly. The purpose of this paper is to describe the long-term outcomes of this innovative surgical technique.

Methods: Monocentric cross-sectional study including consecutive patients affected by facial palsy with an absolute deficiency of tear secretion (Schirmer test 0 mm/5 min) who underwent lacrimal gland neurotization, as previously described. Before surgery (T0) and at the last follow-up visit (T1), the following parameters were evaluated: tear film break-up time (TBUT), corneal fluorescein staining (Oxford score), Schirmer test type I, usage of tear substitutes (daily number of instillation). At T1, subjective satisfaction with surgery was collected and tear film osmolarity (TFO) was measured in both operated and contralateral eye. Corneal sensitivity was performed at T0 and T1 in patients who underwent neurotization of both lacrimal gland and cornea due to the concomitant presence of neurotrophic keratopathy (trigeminal nerve palsy).

Results: Data from 9 patients (4 M, 5 F; mean age 47.1 ± 17.1 years) who underwent lacrimal gland neurotization and were followed up for an average time of 87 months (± 15) (range 60-108) were analyzed. The study procedure was combined in all cases with facial reanimation, while corneal neurotization was performed in 4 cases. At T1, the mean value of Schirmer test was significantly higher compared to T0 (5.8 ± 2.0 vs 0 ± 0 mm/5 min; p < 0.0001). TBUT and corneal fluorescein staining were significantly better compared to baseline (respectively, 2.4 ± 1.8 vs 1.2 ± 0.6 s, p = 0.04 and 1.7 ± 0.8 vs 3.1 ± 0.6, p = 0.0004). TFO was not significantly different between operated eye and contralateral one (306.7 ± 9.5 mOsm/L vs 308.9 ± 11.3 mOsm/L, p = 0.67). The mean daily number of tear substitute instillations was lower at T1 compared to T0 (12 ± 7 vs 21.8 ± 4.3; p = 0.011). Overall, all patients were satisfied with surgery at T1 (very satisfied: n = 3 and satisfied: n = 6). No major postoperative complications were recorded throughout the entire follow-up.

Conclusion: Lacrimal gland neurotization through the sural nerve is a safe and effective procedure with stable favorable outcomes in the long term.

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来源期刊
CiteScore
5.40
自引率
7.40%
发文量
398
审稿时长
3 months
期刊介绍: Graefe''s Archive for Clinical and Experimental Ophthalmology is a distinguished international journal that presents original clinical reports and clini-cally relevant experimental studies. Founded in 1854 by Albrecht von Graefe to serve as a source of useful clinical information and a stimulus for discussion, the journal has published articles by leading ophthalmologists and vision research scientists for more than a century. With peer review by an international Editorial Board and prompt English-language publication, Graefe''s Archive provides rapid dissemination of clinical and clinically related experimental information.
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