Minimalinvasive Tränenwegschirurgie mit einem multimodalen Konzept zur Therapie funktioneller Tränenwegsstenosen

Zusammenfassung

Hintergrund: Es war das Ziel dieser Studie, Langzeitresultate der Behandlung funktioneller Tränenwegsstenosen (functional nasolacrimal duct obstruction, FNLDO) mit einem multimodalen Konzept zu erhalten. Dies besteht aus einer minimalinvasiven Tränenwegsendoskopie in Kombination mit einer Mikrodrilldakryoplastik und einer Tränenwegsintubation sowie ggf. zusätzlicher Chirurgie der Lider, der Tränenpünktchen und/oder der Bindehaut. Patienten und Methoden: Die klinischen Ergebnisse und subjektiven Beschwerden von 118 konsekutiven Fällen, die mit der Hauptdiagnose „funktionelle Tränenwegsstenose“ operiert wurden, wurden retrospektiv ausgewertet. Ergebnisse: Von den 118 Fällen wurden 64 % ausschließlich mit einer transkanalikulären Mikroendoskopie in Kombination mit einem Mikrodrill behandelt, wohingegen weitere 36 % eine zusätzliche Behandlung der Lider oder der Bindehaut benötigten. In 76 % aller Fälle (82 % in der Gruppe der nur mit Mikrodrill behandelten Patienten) berichteten die Patienten, dass sich ihre Beschwerden hinsichtlich des Tränens nach einer mittleren Nachbeobachtungszeit von 14 Monaten gebessert hatten. Bis zum Alter von 70 Jahren waren mehr Frauen von einer funktionellen Tränenwegsstenose betroffen, jenseits dieses Alters mehr Männer. Bei älteren Patienten waren weitere Maßnahmen, insbesondere die Straffung der Lider als zusätzliche Maßnahme häufiger erforderlich. Schlussfolgerung: Die transkanalikuläre, endoskopische Tränenwegschirurgie ist allein oder in Kombination mit lid- oder bindehautchirurgischen Maßnahmen, falls notwendig, bei Patienten mit funktionellen Tränenwegsstenosen eine wertvolle und erfolgreiche minimalinvasive Therapieoption mit guten Langzeitergebnissen.

Abstract

Purpose: The aim of this study was to evaluate the long-term success rates of a multimodal concept for treating functional nasolacrimal duct obstruction (FNLDO) consisting of minimally invasive lacrimal duct surgery and additional treatment of the conjunctiva, the puncta or the lids if necessary. Methods: Clinical outcomes and subjective symptoms of 118 consecutive patients with the main diagnosis FNLDO were studied in a retrospective design. Results: Of the 118 cases 64 % were treated by microendoscopy and microdrill only while 36 % needed additional treatments. In 76 % of all cases (82 % in the group of patients who were treated by microdrill only) the patients reported their symptoms to have “improved” after a median follow-up of 14 months. Up to the age of 70 years more women were affected by FNLDO, while it was more common among male patients above this age. In older patients additional treatment especially tightening of the lids was required more frequently. Conclusion: Transcanalicular microendoscopy of the lacrimal duct alone or in combination with additional treatments, if needed, showed satisfactory long-term outcomes in patients suffering from FNLDO and can be considered a valuable and minimally invasive option for these patients.

Schlüsselwörter

funktionelle Tränenwegsstenose - Dakryoendoskopie - Mikrodrill - multimodaler Ansatz - Lacrimal Unit - Tränenwege

Key words

functional acquired nasolacrimal duct obstruction (FNLDO) - dacryoendoscopy - microdrill - multimodal approach - lacrimal unit - nasolacrimal ducts

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