누소관 경유 다이오드 레이저를 이용한 내시경적 누낭비강연결 재개통술의 효과
The Effects of Transcanalicular Diode Laser-Assisted Revision Surgery for Failed Dacryocystorhinostomy
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목적: 누낭비강연결술 후 비강내 실패원인과 누소관 경유 다이오드 레이저를 이용한 내시경적 누낭비강연결 재개통술의 효과에 대해알아보고자 하였다. 대상과 방법: 2009년 3월부터 2011년 2월까지 코눈물관 폐쇄 진단하에 일차 누낭비강연결술 후 실패하여 다이오드 레이저를 이용한내시경적 재개통술을 시행 받은 총 24명 29안을 대상으로 비강내 실패원인, 첫 수술 후 유루 발생 시기, 성공률, 최종 경과 관찰 기간등을 후향적으로 조사하였다. 결과: 일차 누낭비강연결술 실패원인으로 막성폐쇄가 가장 흔하였고(25안, 86.2%) 육아종은 이 중 10안에서 동반되어 나타났다. 증상발생까지의 기간은 평균 14.6개월, 일차 재개통술 후 성공률은 82.1%였고 이후 5안에서 이차 재개통술을 받았으며 모두 성공적 결과를보였다. 2안은 재개통술 후 증상 재발하였으나 가쪽눈꺼풀판띠고정술을 시행 받고 호전되었다. 결론: 일차 누낭비강연결술 후 막성폐쇄가 가장 흔한 실패원인이었으며, 다이오드 레이저를 이용한 재개통술은 좋은 결과를 보였다. 또한 재개통술 후 해부학적인 이상 없이 유루를 계속 호소하는 경우 하안검 이완에 의한 눈물펌프이상을 고려하여 교정을 위한 검사가필요할 것으로 생각한다.
Abstract
Purpose: To determine the intranasal causes of failed dacryocystorhinostomy (DCR) and the effects of transcanalicular diode laser-assisted revision surgery. Methods: Twenty-four patients (29 eyes) who underwent revision surgery for a failed DCR at the Department of Ophthalmology, Ansan Hospital, Korea University between March 2009 and February 2011 were included in the present retrospective study. The intranasal causes of failed DCR, the time of symptoms such as epiphora and discharge after DCR, success rates of revision surgeries and follow-up periods were evaluated. Results: Membranous obstruction was found in 25 eyes (86.2%) and was accompanied with granuloma in 10 eyes; these were the most common causes of failed DCR. The mean time for symptom development after DCR was 14.6 months, the success rate of the first revision surgery was 82.1% and good results were obtained in 5 eyes after the second revision surgery. Recurrence developed in 2 eyes, but symptoms improved after the lateral tarsal strip procedure. Conclusions: Membranous obstruction was the most common intranasal cause of failed DCR and transcanalicular diode laser-assisted revision surgery produced good results. Additionally, in patients with persistent epiphora following anatomically-patent revisional surgery, lacrimal pump failure due to lower eyelid laxity should be considered and corrected.
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