■描述放射性获得性泪道阻塞(RALDO)患者的治疗和结果。
■2018年7月至2023年12月的回顾性图表回顾了所有由一名外科医生接受RALDO手术干预的病例。收集的数据包括人口统计,肿瘤类型和解剖位置,放射治疗(包括辐射类型,剂量,和持续时间),辐射和所报告的溢泪发作之间的间隔,眼增生临床检查,管理,和结果。所有患者在手术前都进行了泪管冲洗。
■研究中纳入了16例平均年龄为63.3岁的患者的17只眼,超过一半的患者为女性(56.3%)。右泪道引流系统(LDS)累及4例(23.6%),左侧受累13例(76.4%)。放射后出现的溢唇症状平均为9.5个月。潜在的肿瘤类型是眼内有四个葡萄膜黑色素瘤,2例皮肤鳞状细胞癌,1例涉及前额和鼻子的基底细胞癌,8例存在鼻窦适应症。一名患者转移到眼眶和眼睑。4例(25%)患者接受外照射放疗(XRT)(1例双侧LDS受累),6例患者(37.5%)接受了调强放疗(IMRT),5例(31.25%)患者接受质子束照射(PBI),1例(6.25%)接受立体定向放疗(SBRT)。15例患者的平均辐射剂量为61.31Gy(1例患者数据缺失)。3个肿块消失,1个小管狭窄,8个小管近端阻塞,2个小管远端阻塞,3个鼻泪管阻塞(NLDO)。治疗基于阻塞的部位和性质,从微创技术如用双管硅胶管或导杆管进行连续扩张到手术干预如泪囊鼻腔吻合术(DCR)或结膜泪囊鼻腔吻合术(C-DCR)。只有10%的初次泪道插管反应良好。在6例接受琼斯管C-DCR作为主要或次要手术的病例中,4例患者表现出泪露改善(67%).有NLDO的三个在外部DCR后表现良好。总的来说,4例患者在第一次手术失败后接受了二次手术,7例患者在初次手术失败后选择了二次手术.平均随访9.6个月(2-24个月)。
■在RALDO患者中,硅胶泪道插管抢救治疗效果不佳,CDCR与琼斯管有较好的效果,虽然不完美,在NLDO的情况下,DCR有很好的结果。
UNASSIGNED: To describe the management and outcomes of patients with radiation-induced acquired
lacrimal duct obstructions (RALDO).
UNASSIGNED: A retrospective chart review from July 2018 to December 2023 of all cases undergoing surgical intervention for RALDO by a single surgeon. Data collected included demographics, tumor type and anatomic location, radiation treatment (including radiation type, dosage, and duration), interval between radiation and reported onset of epiphora, oculoplastic clinical examination, management, and outcomes.
Lacrimal irrigation was done prior to surgery in all patients.
UNASSIGNED: Seventeen eyes of 16 patients with a mean age at presentation of 63.3 years and over half the patients being females (56.3%) were included in the study. The right
lacrimal drainage system (LDS) was involved in 4 (23.6%), and the left side was involved in 13 (76.4%). The mean onset of epiphora symptoms after radiation was 9.5 months. The underlying tumor type were intraocular having uveal melanoma in four, cutaneous squamous cell carcinoma in 2, basal cell carcinoma involving forehead and nose in one and sino-nasal indications present in 8 patients. One patient had metastasis to the orbit and eyelid. Four patients (25%) received external beam radiotherapy (XRT) (one case had bilateral LDS involvement), 6 patients (37.5%) received intensity-modulated radiation therapy (IMRT), 5 patients (31.25%) received proton beam irradiation (PBI), and one (6.25%) received stereotactic body radiotherapy (SBRT). Mean radiation dosage was 61.31 Gy in 15 patients (data was missing in 1 patient). Punctum was effaced in 3, canalicular stenosis in 1, proximal canalicular obstruction in 8, distal canalicular obstruction in 2, and nasolacrimal duct obstruction (NLDO) in 3. Treatment was based on the site and nature of obstruction and varied from minimally invasive techniques like serial dilatation with bicanalicular silicone tube or Guibor tube to surgical interventions like dacryocystorhinostomy (DCR) or conjunctivo-dacryocystorhinostomy (C-DCR). Only 10% with primary
lacrimal intubation had good response. Of the six cases that underwent C-DCR with Jones tube either as primary or secondary procedure, four cases showed improvement in epiphora (67%). Three with NLDO did well after external DCR. In total, four patients had a secondary procedure after the first failed while 7 with failed initial surgery elected against secondary surgery. The mean follow-up was 9.6 months (range 2-24 months).
UNASSIGNED: In patients with RALDO, salvage treatment with silicone
lacrimal intubation has poor results, CDCR with Jones tube has better results, although imperfect and in cases with NLDO, DCR has good outcomes.