Emel BAŞAR, Çolpan MİRZATAŞ, Nilüfer AKOVA

Nazolakrimal drenaj sistem tıkanıklıklarında antegrad teknik ile balon kateter dilatasyon tedavisi

Çalışmamız yetişkin hasta grubunda, NLDS tıkanıklıklarında 'antegrad' BKD'na ait erken dönem sonuçlarının değerlendirilmesi amacıy¬la planlanmıştır. Topikal anestezi altında 10 hastanın 10 NLDS'ne 'antegrad' BKD uygulanmıştır. NLDS tıkanıklığı tanısı Jones I-H testleri ile konulmuş ve Munk kriterlerine göre evrelendi-rilmiştir. Tıkanıklığın yeri DSM tekniği kulanı-larak gösterilmiştir. İşlem 'Lacricath' balon ka¬teter seti kullanılarak gerçekleştirilmiştir. Sadece ortak kanalikülde total tıkanıklık iz¬lenen 1 olguda lezyon kateter ile geçilememiş¬tir. 3 aylık takip süresi sonunda parsiyel tıka¬nıklığı olan 7 ve total tıkanıklığı olan 2 olguda klinik başarı sağlanmıştır. İşlem esnasında her¬hangi bir komplikasyon izlenmemiştir. Bu ön çalışmamızda 'antegrad' BKD kısa dönem sonuçları ile değerlendirildiğinde topi-kal anestezi altında uygulanabilen, güvenli ve etkin bir tekniktir. Daha geniş çalışma serileri ile uzun dönemli takip sonuçları bu yöntemin yaygınlaşmasında daha etkin rol oynayacaktır.

Treatment of the nasolacrimal drainage system obstructiıon with the antegrade balloon catheter dilation

Background.- The purpose of this study is to evaluate the our short-term experience with the antegrade balloon catheter dilation (BCD) to treat nasolacrimal drainage system (NLDS) obstruction in adult patients. Design.- Antegrade BCD was performed for only one side of ten patients under topical anesthesia. Obstruction of NLDS, was diagnosed by Jones I and II tests and it was graded subjectively according to Munk.s criteria The site of obstruction was demonstrated by digital substraction macrodacryocystography (DSM). Lacricath balloon catheter set was used for the procedure. Results.- Initial tecnichal and clinical success was satisfactory for 9 cases. Only in one case with common canaliculus total occlusion, the lesion could not have been crossed with the catheter. In a follow up period of 3 months, clinical success was achieved for 7 partial and 2 total obstruction cases. No serious complication was seen during the procedure. Conclusion.- We don.t know yet for the long-term recurrence rates but the short-term effectiveness of BCD with antegrade technique under topical anesthesia is satisfactory for the treatment of epiphora as an office procedure.

PDF

___

1. Christenbury JD. Translacrimal laser dacryocystorhinostomy. Arch Ophthalmol 1992; 110: 170-171. 2. Levin PS, Stormogipson DJ. Endocanalicular laser asssisted dacryocystorhinostomy: an anatomic study. Arch Ophthalmol 1992; 110: 1488-1490 3. Silkiss RZ, Axelrod RN, Iwatch AG, Vasillaidis A, Hennings DR. Transcanalicular THC: YAG dacryocystorhinostomy. Ophthalmic Surg 1992; 23: 351- 353. 4. Massaro BM, Gonnering RS, Harris GJ. Endonasal laser dacryocystorhinostomy: a new approach to nasolacrimal duct obstruction. Arch Ophthalmol 1990; 108: 1172- 1176. 5. Gonnering RS, Lyon DB, Fischer JC. Endoscopic laser assisted lacrimal surgery. Amj Ophthalmol 1991; 11: 152-157. 6. Saphiro A, Dan JA. Restoration of patency of the nasolacrimal system. Opht Plast Reconstr Surg 1997; 13: 210-215. 7. Munk PL, Lin DT, Morris DC Epiphora: treatment by means of dacryocystoplasty with balloon dilation of the nasolacrimal drainage apparatus. Radiology 1990; 177: 687-690.
8. Robinson R, Turner N, Brettle P, Chell PB, Chavda SV, Murray PI. The treatment of epiphora with balloon dacryocystoplasty. Eye 1993; 7: 687-690. 9. Lee JM, Song HM, Han YM, Chung GH, Sohn MH, Kim CS, Choi KC. Balloon dacryocystoplasty: results in the treatment of complete and partial obstructionsof the nasolacrimal system. Radiology 1994; 192: 503-508. 10. Liermann D, Berkefeld J, Fries U, Schalnus RW, Gumpel H. Balloon dacryoplasty: an alternative treatment for obstructed tear ducts. Ophthalmologica 1996; 210: 319- 324. 11. Becker BB, Berry FD. Balloon catheter dilation in lacrimal surgery. Ophthalmic Surg. 1989; 20: 193-198. 12. Perry JD, Maus M, Nowinski TS. Balloon catheter dilation for treatment of adults with partial nasolacrimal duct obstruction: a preliminary report. Am J Opthalmol 1998; 126: 811-816. 13. Hornblass A, Herschorn BJ. Lacrimal diagnosis. Smith's Ophthalmic Plastic and Reconstructive Surgery'de. Ed. Nesi FA, Lisman RD, Levine MR. Second Edition St Lois, Mosby. 1998; 648-653. 14. Başar E, Demir M, Akman C, Islak C, Mirzataş C. Epiforalı olgularda dijital sustraksiyon makrodakriosistografı. Cerrahpaşa Journal of Medicine 1998; 29: 123-126 15. King SJ, Haigs SF. Technical Report: Digital substraction dacryocystography. Clin Radiol 1990; 42: 351- 353. 16. Linberg JV, McCormik SA. Primary acquired nasolacrimal duct obstruction: a clinicopathologic report and biopsy technique. Ophthalmology 1986; 93: 1055- 1063.
17. Ilgıt ET, Yüksel D, Ünal M, Akpek S, Işık S, Hasanreisoğlu B. Transluminal balloon dilation of the Lacrimal drainage system for the treatment of epiphora. AmJofRoentgenol 1995; 165: 1517-1527. 18. Janssen AG, Mansour K, Krabbe GJ, Van der Veen S, Helder AH. Dacryocystoplasty: treatment of epiphora by • means of balloon dilation of the obstructed nasolacrimal duct system. Radiology 1994; 193: 453-456. 19. Kumar EN. Technical note: non-surgical treatment of epiphora by balloon dacryocystoplasty -The technique. BrJ Radiol 1995; 68: 1116-1118. 20. Kuchar A, Steinkogler FJ. Antegrade balloon dilation of nasolacrimal duct obstructions in adults. Br J Ophthalmol 2001; 85: 200-204