使用前段光学相干断层扫描和泪道镜检查评估管腔裂孔修复术的解剖和功能成功率

IF 3.1 3区医学 Q2 ONCOLOGY

Photodiagnosis and Photodynamic Therapy Pub Date : 2025-02-01 DOI:10.1016/j.pdpdt.2024.104443

Çisil Erkan Pota , Özge Ekin Geçer Şerifoğlu , Aslı Çetinkaya Yaprak , Hatice Deniz İlhan , Adil Boz

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引用次数: 0

摘要

目的：评估接受管状裂伤手术但未出现明显眼外窥的患者的解剖和功能结果，并将这些结果与未受伤的对侧眼进行比较：方法：对 24 名接受了管状裂伤修复手术且无明显眼外窥症状、随访至少 6 个月的患者进行了泪道镜造影、前节光学相干断层扫描（OCT）、MUNK 评分和满意度问卷调查。使用前段 OCT 测量了泪液半月板的高度（TMH）、深度（TMD）和面积（TMA），并与未受伤眼睛的数值进行了比较：16名患者（67%）有下眼管裂伤，7名患者（29%）有上眼管裂伤，1名患者（4%）两眼管均有裂伤。五名患者（20.83%）同时伴有眼眶骨折，三名患者（12.5%）因角膜巩膜裂伤接受了额外的修复手术。一名患者进行了双腔硅胶管插管，其他患者均使用了迷你莫诺卡支架插管。平均随访时间为（41 ± 22.3）个月，外伤与手术之间的平均间隔时间为（30.2 ± 29）小时。拔管前的平均时间为 3 ± 2.54 个月。8 名患者（33%）的 MUNK 评分为 1 分，16 名患者（67%）的 MUNK 评分为 0 分。有 8 名患者的耳道裂伤是由于家庭事故造成的，4 名患者是由于工作事故造成的，5 名患者是由于袭击造成的，7 名患者是由于交通事故造成的。在动态成像中，泪道镜造影显示有 12 名患者的示踪剂排入鼻腔。5 名患者的泪囊有潴留，4 名患者的引流时间延长但引流量减少，1 名患者的引流量减少，2 名患者在第一和第二小时的图像中没有引流。手术眼的平均泪液半月板高度（TMH）为 279.6 μm，深度（TMD）为 215 μm，面积（TMA）为 28.9 μm²。健康眼的平均 TMH 为 221.5 μm，TMD 为 152.5 μm，TMA 为 15.3 μm²。从统计学角度看，患眼的前段 OCT 值明显高于健眼（TMH 的 p=0.044，TMD 的 p=0.003，TMA 的 p=0.006）。MUNK评分为1分的患者的TMD和TMA在统计学上明显更高（TMD的p=0.019，TMA的p=0.05）。眼球损伤需要进行额外手术的患者中，泪道镜造影结果异常的情况更为常见：虽然患者在进行管状裂伤修补术后并未报告有口咽现象，但我们的观察结果表明，与健康眼相比，患者的泪道镜造影和眼前节 OCT 存在潜在的功能和解剖学差异。我们认为，密切随访对于识别和解决术后可能出现的任何问题至关重要。

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Evaluation of anatomical and functional success in canalicular laceration repair using anterior segment optical coherence tomography and dacryoscintigraphy

Purpose

To assess the anatomical and functional outcomes in patients who underwent surgery for canalicular laceration and did not experience significant epiphora, and to compare these outcomes with contralateral uninjured eye.

Method

Dacryoscintigraphy, anterior segment optical coherence tomography (OCT), MUNK scores, and a satisfaction questionnaire were administered to 24 patients who had canalicular laceration repair without significant epiphora and had a minimum of 6 months of follow-up. Tear meniscus height (TMH), depth (TMD), and area (TMA) were measured using anterior segment OCT and compared with the values in the uninjured eye.

Results

Sixteen patients (67 %) had lower, 7 (29 %) had upper canaliculus, and one (4 %) had lacerations in both canaliculi. Five patients (20.83 %) had concomitant orbital fractures, and three patients (12.5 %) underwent additional repair for corneoscleral laceration. Bicanalicular silicone tube intubation was performed in one patient, while Mini-Monoka stent intubation was used for all other patients. The mean follow-up period was 41 ± 22.3 months, and the mean interval between trauma and surgery was 30.2 ± 29 h. The mean duration until tube removal was 3 ± 2.54 months. The MUNK score was 1 in eight patients (33 %) and 0 in sixteen patients (67 %). Canalicular lacerations occurred due to home accidents in 8 patients, work accidents in 4, assaults in 5, and traffic accidents in 7.

Dacryoscintigraphy showed drainage of tracer into the nasal cavity in dynamic imaging for 12 patients. Five patients had retention in the sac, four had prolonged and reduced drainage, one had reduced drainage, and two showed no drainage in the first and second hour images. In the operated eye, the mean tear meniscus height (TMH) was 279.6 µm, depth (TMD) was 215 µm, and area (TMA) was 28.9 µm². In the healthy eye, the mean TMH was 221.5 µm, TMD was 152.5 µm, and TMA was 15.3 µm². The anterior segment OCT values for the affected eye were statistically significantly higher than those for the healthy eye (p = 0.044 for TMH, p = 0.003 for TMD, p = 0.006 for TMA). TMD and TMA were statistically significantly higher in patients with a MUNK score of 1 (p = 0.019 for TMD, p = 0.05 for TMA). Abnormal dacryoscintigraphy results were more common in patients with globe injuries requiring additional surgery.

Conclusion

Although patients did not report epiphora after canalicular laceration repair, our observations indicated potential functional and anatomical differences in dacryoscintigraphy and anterior segment OCT compared to their healthy eyes. We believe that close follow-up is crucial to identify and address any issues that may arise in the future following surgery.

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来源期刊

Photodiagnosis and Photodynamic Therapy ONCOLOGY-

CiteScore

5.80

自引率

24.20%

发文量

509

审稿时长

50 days

期刊介绍： Photodiagnosis and Photodynamic Therapy is an international journal for the dissemination of scientific knowledge and clinical developments of Photodiagnosis and Photodynamic Therapy in all medical specialties. The journal publishes original articles, review articles, case presentations, "how-to-do-it" articles, Letters to the Editor, short communications and relevant images with short descriptions. All submitted material is subject to a strict peer-review process.