Topicality. Endoscopic and laser processing technologies in dacryocystitis surgery has been quickly developing since the beginning of the 90-s of the XX century. The specified technologies provided the practical application of endonasal (retrograde) and transcanalicular laser endoscopic dacryocystorhinostomy (TLED). In ophthalmosurgery the transcanalicular approach to the lacrimal sac has gained the greatest extension as its main advantages, compared to the traditional external approach, are the lack of cicatrix on skin, little traumatism and bleeding and also a more simple surgery technique. According to the integrated data of scientific literature the efficiency of primary TLED varies from 58 to 85% and the success of reoperations usually doesn´t exceed 50%, the application of transient stenting at reoperations allowing achieving higher positive results.
The purpose of the work - is to study the efficiency of bi-canalicular silicon intubation application at repeated TLED.
Materials and methods. The bi-canalicular silicon intubation TLED reoperations´ results analysis was carried out in 14 patients (14 eyes) because of ineffectiveness of the primary operation. There were 4 (28,6%) men and 10 (71,4%) women. The patients´ age varied from 17 to 69 years old (the average age was 43,9+3,0 years). The reoperation was carried out at terms from 3 months to 1,5 years after the primarily executed interventions (in 12 (85,7%) patients during the first year after the surgery).
The operations were carried out using diode laser ОМЕ-1150 of the firm «Endo Optics» (USA) and endoscopic apparatus «Stozz» (Germany). For the intubation of lacrimal ways we used a lacrimal set of Ritleng (F.C.I., France) and a silicon stent (diameter of 0,64 cm and 30 cm long), which was set in for 3 months. All the patients were examined within long date: in 6 months-2 years (the average term for the examination was 16,4±1,9 months).
Results and discussing. During the operation a moderate bleeding was observed in two patients (14,3%). In the early postoperative period complications took place in 3 patients in 4 cases (28,6%). In the first case (7,1%) on the 2nd day after the reoperation a rather frank irritation of the eye conjunctiva mainly in the area of medial angle, which was evaluated by us as an allergic response for the silicon drainage material, that required carrying out, besides the corticosteroid (dexametason drops) therapy, non-steroid anti-inflammatory (diclof) antiallergic (cromohexal, hi-crom) ones in the postoperative period. Though the specified treatment reduced the irritation, it didn´t liquidate it completely. More over, a granulation polyp (7,1%) located in the nasal cavity at the edge of the formed inosculation was detected in the specified patient in 1,5 months after the reoperation. It gave occasion to the prescheduled and constrained elimination of the silicon stent, whereafter the intubation granuloma was removed by forceps under local anaesthesia and endoscopic control.
At the stage of bi-canalicular intubation technique mastering the silicon drainage ends decoupling followed by its falling out (7,1%) was observed in 1 patient in 10 days after the reoperation, that didn´t influence negatively the surgery result. In our opinion, the specified complication was caused by a reflex sneezing and coughing of the patient owing to periodic depression of free and relatively long ends of the silicon stent into the nasopharynx.
In the other case in 2 months after the surgery the breakdown of both lacrimal points and canaliculi (7,1%) followed by the adhesion of eye-lids´ skin and the lips of the incised canaliculi was registered.
By the day of release the functional result had been achieved in all the patients. At long date (up to 2 years) a positive effect with the recovery after the reoperation with bi-canalicular silicon intubation was registered in 11 patients or in 78,6% of the cases. The backsets of purulent dacryocystitis occurred in 11 patients (21,4%) in 2, 3 and 18 months after the reoperation accordingly, in 2 of the given three patients the backsets being connected with the silicon stent implantation. In one case the backset was observed after the lacrimal canaliculi eruption with medial migration of the intubation material, in the other one - in the patient with an allergic response to the silicon drainage and the granuloma formation in the inosculation area.
The reoperation with the use of transient drainage was executed for a third time and with a partial success in 2 patients.
Conclusions
- In long date (up to 2 years) after the repeated transcanalicular laser dacryocystorhinostomy with transient bi-canalicular silicon intubation a positive result was registered in 78,6 % of the cases.
- omplications in the early period of the given surgery (intubation granuloma, lacrimal points and canaliculi eruption, allergic response on the silicon drainage, stent falling out) were observed in almost 1/3 of the patients. Taking into account this fact the search for more perfect intubation materials remains topical. In our opinion, a biodegradable (resolving) drainage can be optimal in this respect.
The article is admitted to the International Scientific Conference «Present-day problems of experimental and clinical medicine», Thailand, February 20-28, 2008, came to the editorial office on 29.11.07