Punktum Tıkanıklığı Tedavisinde Uygulanan Farklı Cerrahi Teknikler ve Sonuçlarının Retrospektif Olarak Değerlendirilmesi
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Tarih
2022
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Tekirdağ Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Punktal stenoz, gözyaşı kanalının dış açıklığının daralması ya da tamamen tıkanması anlamına gelir. Doğuştan ya da edinsel olabilir. En sık sebebi kronik blefarittir. Enfeksiyonlar, yaşlanma, inflamasyon, topikal uygulanan ilaçlar, sistemik kemoteröpatik ilaçlar diğer sebeplerdir. Tedavide amaç yeterli punktum açıklığı sağlamak ve lakrimal pompa fonksiyonunu korumaktır. Altın standart bir tedavi yöntemi henüz yoktur. Çalışmamızda punktum stenozu nedeniyle farklı cerrahi teknikler uygulanan hastaların cerrahi öncesi ve sonrası bulguları geriye dönük incelenmiştir. Çalışmamıza 142 hastanın 259 gözü dahil edildi. Uyguladığımız cerrahi yöntemler; üçlü kesi punktoplasti, üçlü kesi punktoplasti + 5FU-MMC, mikropunch punktoplasti, mikropunch punktoplasti + 5FU-MMC, mikropunch punktoplasti + TA, bikanaliküler pigtail yardımlı silikon entübasyon, bikanaliküler pigtail yardımlı silikon entübasyon + 5FU-MMC ve punktokonjonktival flep tekniğidir. Çalışmamıza dahil edilen 142 hastanın yaş ortalaması 65,08±14,08 yıldır. Hastaların %52,1'i kadın, %47,9'u erkektir. Hastaların %82,4'üne (117 hasta) bilateral, 25 hastaya unilateral cerrahi uygulanmıştır. En sık uyguladığımız cerrahi Üçlü kesi + 5FU-MMC'dir.. Birincil işlemler sonrasında restenoz üst punktumda 18, alt punktumda 39 gözde görülmüştür. Restenoz gelişim süresi üst ve alt punktum için de en sık ilk 1 aydır. Birincil işlemler sonrasında gözlerin %76,1'inde epifora tamamen, %21,6'sında kısmen düzelmiştir. Epiforası kısmen düzelen hastalara ikincil ve üçüncül işlemler yapılmıştır. Cerrahi yöntem grupların karşılaştırıldığında üst ve alt punktum için hem anatomik hem fonksiyonel başarı açısından anlamlı bir fark görülmemiştir. Punktum stenozu epiforaya sebep olabilen farklı etyolojik faktörlerin yol açtığı bir hastalıktır. Hasta semptomatikse risk faktörleri iyi değerlendirildikten sonra uygun cerrahi planlama yapılmalıdır.
Punctal stenosis refers to narrowing or complete obstruction of the external opening of the tear duct. It can be congenital or acquired. The most common cause is chronic blepharitis. Infections, aging, inflammation, topically applied drugs, systemic chemotherapeutic drugs are other causes. The aim of treatment is to provide adequate punctal opening and to preserve lacrimal pump function. There is no gold standard treatment method yet. In our study, the pre- and post-surgical findings of patients who underwent different surgical techniques for punctal stenosis were examined retrospectively. 259 eyes of 142 patients were included in our study. The surgical methods we apply; triple incision punctoplasty, triple incision punctoplasty + 5FU-MMC, micropunch punctoplasty, micropunch punctoplasty + 5FU-MMC, micropunch punctoplasty + TA, bicanalicular pigtail assisted silicone intubation, bicanalicular pigtail assisted silicone intubation + 5FU-MMC and punctoconjunctival flep technique. The mean age of 142 patients included in our study was 65,08±14,08 years. 52,1% of the patients were female and 47,9% were male. Bilateral surgery was performed in 82,4% (117 patients) of the patients and unilateral surgery was performed in 25 patients. The most frequently performed surgery is Triple incision + 5FU-MMC. After primary procedures, restenosis was seen in 18 eyes in the upper punctum and in 39 eyes in the lower punctum. Restenosis development time is most common in the first 1 month for the upper and lower punctum. After the primary procedures, the epiphora was completely resolved in 76,1% of the eyes and partially resolved in 21,6%. Secondary and tertiary procedures were performed on patients whose epiphora partially resolved. When the surgical method groups were compared, no significant difference was observed in terms of both anatomical and functional success for the upper and lower punctum. Punctal stenosis is a disease caused by different etiological factors that can cause epiphora. If the patient is symptomatic, appropriate surgical planning should be performed after the risk factors are well evaluated.
Punctal stenosis refers to narrowing or complete obstruction of the external opening of the tear duct. It can be congenital or acquired. The most common cause is chronic blepharitis. Infections, aging, inflammation, topically applied drugs, systemic chemotherapeutic drugs are other causes. The aim of treatment is to provide adequate punctal opening and to preserve lacrimal pump function. There is no gold standard treatment method yet. In our study, the pre- and post-surgical findings of patients who underwent different surgical techniques for punctal stenosis were examined retrospectively. 259 eyes of 142 patients were included in our study. The surgical methods we apply; triple incision punctoplasty, triple incision punctoplasty + 5FU-MMC, micropunch punctoplasty, micropunch punctoplasty + 5FU-MMC, micropunch punctoplasty + TA, bicanalicular pigtail assisted silicone intubation, bicanalicular pigtail assisted silicone intubation + 5FU-MMC and punctoconjunctival flep technique. The mean age of 142 patients included in our study was 65,08±14,08 years. 52,1% of the patients were female and 47,9% were male. Bilateral surgery was performed in 82,4% (117 patients) of the patients and unilateral surgery was performed in 25 patients. The most frequently performed surgery is Triple incision + 5FU-MMC. After primary procedures, restenosis was seen in 18 eyes in the upper punctum and in 39 eyes in the lower punctum. Restenosis development time is most common in the first 1 month for the upper and lower punctum. After the primary procedures, the epiphora was completely resolved in 76,1% of the eyes and partially resolved in 21,6%. Secondary and tertiary procedures were performed on patients whose epiphora partially resolved. When the surgical method groups were compared, no significant difference was observed in terms of both anatomical and functional success for the upper and lower punctum. Punctal stenosis is a disease caused by different etiological factors that can cause epiphora. If the patient is symptomatic, appropriate surgical planning should be performed after the risk factors are well evaluated.
Açıklama
Anahtar Kelimeler
Göz Hastalıkları, Eye Diseases
