| Background: Canalicular laceration is a common type of ocular trauma. The canalicular anastomosis combined with canalicular stent intubation is the common treatment method. At present, most of the study on canalicular laceration, regardless of the epidemiology, treatment methods, prognosis evaluation, are limited to the primary canaliculus laceration, failed to include the old canalicular laceration. Canalicular stenosis or obstruction after canalicular anastomosis is an important factor affecting long-term effects. Regular lacrimal irrigation is recommended after surgery in order to improve the long-term effect of the surgery. But the effectiveness was not studied in detail.Glucocorticoids eye drops are commonly used to inhibit scaring stenosis after surgery. But its side effects limited the long-term use. Doctors hope to find a safe and effective anti-inflammatory and anti-scaring drugs. Berberine(BBR) is a monomer extracted from traditional Chinese medicine. It has been shown to inhibit the occurrence of intestinal adhesions after intestinal surgery. But the effect of berberine on lacrimal duct surgery has not been investigated.Objectives: To summarize the epidemiological data, clinical profile, the surgical approach and surgical outcome and prognostic factors of canalicular lacerations (including primary CL and old CL), and to provide the basis for follow-up study. To study regular lacrimal irrigation on the long-term effect of CL repair, and to provide ideas for follow-up study. Anti-inflammatory and anti-scaring effects of BBR on rabbit CL repair model and its molecular mechanism.Methods: This study consists of three parts. 1. A retrospective review of CL repairs at the Lacrimal Center of Ophthalmology, Armed Police General Hospital of China was performed. Analyzed data included demographics, clinical profile, the surgical approach,follow up and surgical outcome. And to analyze the impact of various factors on surgical outcome. 2. After the data of patients with CL at the center were researched, the patients were divided into two groups patients in accordance with whether the postoperative lacrimal irrigation can be achieved. A prospective review of surgical outcome was performed. To evaluate the effect of lacrimal irrigation on prognosis by the method of preference score matching. 3. The rabbits CL model combined with canalicular stent intubation was made. BBR and control medicine are topically used. The pathological changes and expression of TGF-?1,CTGF,ICAM-1,IL-1? and p-p38, p38, p-ERK1 and ERK1 in BBR group and control group were detection and analysis.Results: 1. Males and adult were majority in CL. The single lower canalicular involvement was the most common in primary CL and bicanalicular involvement was the most common in old CL. Lacrimal sac and nasolacrimal duct injury combined were more common in old CL. Chronic dacryocystitis after trauma is only seen in old CL. Anatomic success of the canalicular anastomosis combined with canalicular stent intubation was 96.9% and functional success was 98.1% in primary CL. Anatomic success of the canalicular anastomosis combined with canalicular stent intubation with or without dacryocystorhinostomy was 91.7%, functional success was 87.5% and functional improvement was 96.5% in the old CL. The long-term effects of the CL repair were related to the time from injury to the repair,which canaliculus involved,chronic dacryocystitis resulted from the posttraumatic nasolacrimal duct obstruction. The difference was statistically significant. The long-term effects might also be associated with concomitant orbit fracture, the mean time of removal stent, secondary canaliculitis, punctal and canalicular slitting and regular lacrimal irrigation. 2. Before PSM, the complete success rate of experimental group ( lacrimal irrigation group) was 96.3%,control group was 69.6%, and RR rate was 0.12(P<0.05). The difference was statistically significant. After PSM, the complete success rate of experimental group ( lacrimal irrigation group) was 94.1% , control group was 58.9%, and RR rate was 0.14(P < 0.05). The difference was statistically significant. 3. The pathological results of animal experiments showed milder inflammation and milder fibration in the BBR groups compared with control group.Immunohistochemistry and reverse transcription-PCR (RT-PCR) results showed significant lower expression of TGF-?1?CTGF?ICAM-1 and IL-1?,in BBR groups compared with the control group. The results of western blot (WB) activities of phosphorylated p38 and phosphorylated ERK were inhibited in the BBR groups compared with control group. The better results were shown in the solution of BBR compared with the gel of BBR and in higher concentration group compared with lower concentration group. The rabbit ocular surface were basically normal in all BBR group.Conclusion: The long-term effects of the CL repair were related to the time from injury to the repair, which canaliculus involved, chronic dacryocystitis resulted from the posttraumatic nasolacrimal duct obstruction, and might also be associated with concomitant orbit fracture, the mean time of stent removal, secondary canaliculitis, punctal and canalicular slitting and so on. Regular lacrimal irrigation is a protective factor for complete success in CL repair. The shorter time from injury to repair might be a positive factor for complete success. The local use of BBR in the rabbit CL model can achieve anti-inflammatory and anti-scaring effect. |
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