Chronic Lacrimal Duct Obstruction And Acryocystitis Minimally Invasive Therapy Experimental And Clinical Research

ObjectiveChronic lacrimal passage obstruction and dacryocystitis are common diseases of ophthalmology, but it is also necessary to eliminate before surgery. This study consists of two parts:the first is to explore experimental study for a rapid, radical and minimally invasive method of dacryocystitis to replace the lacrimal sac excision. The second part is retrospective clinical study to explore the use of patented products with independent intellectual property rights of lacrimal passage struction and dacryocystitis patients with Trephination and Plasty on the lacrimal Passage via Punctum.Methods1.New Zealand rabbits were chosen as test animals, the seven rabbits were randomly divided into control group (a rabbit), PYM group (six left eye), fosfomycin sodium glucose (6 right eye). Drugs for the control group:0.9% saline; PYM group drugs:PYM, dexamethasone, lidocaine,0.9% saline; Fosfomycin sodium group:Fosfomycin sodium,50% glucose. Inject different hardener to rabbit lacrima1.1 week and 2 weeks later isolate lacrimal sac and observe the pathological changes.2.In this retrospective cases series,90 patients with nasolacrimal passage obstruction between 2006 and 2009 from Tianjin Medical University General Hospital, include chronic lacrimal passage obstructive 40 cases, chronic dacryocystitis 43 cases, acute dacryocystitis 7 cases. whose age ranged from 22 to 86 years old (average 53 years old) underwent trephining and shaping on the lacrimal passage. who received unsuccessful probing procedure previously. The therapeutic effect including dacryorrhea disappearance and lacrimal passages excretory function regaining was observed and the complications were recorded. The follow-up period was from 3 to 32 months(average 10 months). Analyze efficacy, complications, the elements which influence the efficacy of the surgery.Results1.No significant change in the control group, the mucosa is columnar epithelium, the basic strcture of the lacrimal mucosa is normal; 1 week later, PYM group lacrimal duct is still smooth, mucosa edema, hyperplasia, with infiltration of inflammatory cells; fosfomycin sodium glucose group lacrimal is not smooth, mucosa edema, proliferation, infiltration of inflammatory cells; 2 weeks later, PYM group lacrimal passage is still smooth, lacrimal epithelial cell hyperplasia and disarray, a small amount of epithelial cells into the soft tissue; fosfomycin sodium glucose group, inflammatory cell infiltration in lacrimal passage, amount of epithelial cells deficiency, blood and collagen exude to cavity, lacrimal sac occlusion, obvious atrophy.There are no significant systemic reactions.2.Dacryorrhea disappeared in 77 eyes(85.6%),9 eyes(10%) relief from symptoms and 4 eyes(4.4%) were ineffective. The complications including inferior palpebra skin edema congestion,18 eyes (20%) tube take off.4 eyes (4.4%) canaliculus avulsion.In 43 cases chronic dacryocystitis,33 eyes (76.7%) cured,7 eyes (16.3%)relief,3 eyes(7.0%) were ineffective. Swelling of acute dacryocystitis were removed two or three weeks after the surgery. Purulence disappear in 5 cases,irrigate smooth.2 cases still has little purulence.Conclusions1.Fosfomycin sodium glucose sclerotherapy on Rabbit lacrimal passage has better occlusion function of lacrimal, two weeks can lead to the lacrimal atrophy, efficacy and safety are superior to PYM. It mainly result in the wall thickening caused by collagen fibers proliferate, fewer side effects and complications, taking into account the hypertonic sugar and fosfomycin sodium can be reabsorpted in the human body,has less residue, no stimulation, fosfomycin sodium can also control bacterial infection.it can be applied to patients who with chronic dacryocystitis but do not want surgery, has important clinical value.2.Trephining and shaping on the lacrimal duct(TPLD) is an easy grasp, safety, economical, effective and nontraumatizing procedure for lacrimal passage obstruction, it is more effective to treat chronic lacrimal passage obstructive disease than chronic dacryocystitis.The agreement of the patients is very important.This method may be widely used in China.