Application of MMC for prevention of excessive scarring after EEDCR is impractical as it is not possible to achieve antifibrotic concentration of the drug at dacryocystorhinostomy ostium site using this method.
Purpose: To conduct a morphological study of structural changes in the nasolacrimal duct in secondary acquired nasolacrimal duct obstruction (SALDO) as a result of treatment with radioiodine. Methods: Twenty patients (20 cases) were involved: 10 cases with secondary acquired nasolacrimal duct obstruction at Hasner’s valve level due to the treatment with radioiodine (group 1) and 10 cases with primary acquired nasolacrimal duct obstruction (group 2). During surgery, a biopsy of nasolacrimal duct tissue from Hasner’s valve area was taken. A morphological study was performed using semi-fine sections technique. Results: Patients of group 1 showed the following: desquamation of columnar epithelium, pinpoint ulceration of nasolacrimal duct wall, collapse of a significant part of the capillary bed, and absence of blood cells in their lumen. State of secretory cells of mucous glands varied from necrobiotic to the different stages of dystrophic, decreased lumens of acini with abundant microvesicles in cell cytoplasm were revealed. A specific sign noted in patients of group 2 was mixed inflammatory infiltration of the mucosa of the nasolacrimal duct. The picture corresponds to the exacerbation of a chronic inflammatory process. Conclusions: Changes revealed in patients of group 1 include desquamation of nasolacrimal duct epithelium, mucous gland lesion, and moderate fibrosis that indicate a probable primary character of the lesion. In patients of group 2, fibrotic changes were more significant and were due to a chronic inflammatory process. Thus, secondary acquired nasolacrimal duct obstruction after treatment with radioactive iodine has a specific pathogenesis and should be classified as a separate nosological form.
Основным источником рецидивов после эндоскопической эндоназальной дакриоцисториностомии (ДЦр) является заращение сформированного искусственного соустья. Однако процессы репарации, протекающие в области дакриостомы после эндоскопической эндоназальной ДЦр, остаются недостаточно изученными. Цель -проведение морфологического анализа процессов репарации в области дакриостомы после эндоскопической эндоназальной ДЦр. материал и методы. в исследование вошли 18 пациенток (18 женщин в возрасте 62,59±10,07 года с облитерацией слезоотводящих путей. всем пациенткам была проведена эндоскопическая эндоназальная ДЦр по модифицированной методике P. Wormald. На 2, 5, 7, 10, 14, 21, 28, 60-е сутки после операции брали биопсию из области дакриостомы. Полученный материал окрашивали гематоксилином и эозином. С целью более детального исследования клеточного состава воспалительного инфильтрата (54 препарата) изучали полутонкие срезы. Полученные гистологические препараты исследовали с помощью фотомикроскопа Leica DM-2500 («Leica», Германия). Фоторегистрацию изображений осуществляли цифровой фотокамерой Leica DFC320 с последующим анализом изображений с помощью программного обеспечения ImageScope Color. Результаты. При гистологическом исследовании выявляли, что в 1-е сутки после операции в исследуемом материале преобладает воспалительный инфильтрат. К 14-м суткам после операции его количество уменьшалось, что свидетельствовало о завершении экссудативной стадии воспаления. Преобладающими клеточными элементами в это время становились активированные фибробласты. К 28-м суткам после операции в биоптатах обнаруживали пролиферирующие фибробласты и коллагеновые волокна. На 60-е сутки после операции отмечали преобладание фибриллярных компонентов над клеточными и их компактизацию. Заключение. результаты исследования показали, что завершение процессов репарации наступает к 60-м суткам после операции. Динамическое морфологическое исследование биоптатов из области, окружающей дакриостому, позволило изучить индивидуальные особенности заживления слизистой оболочки носа и слезного мешка после эндоскопической эндоназальной ДЦр. Ostium closure due to local reparative processes is the most common cause of recurrence after endoscopic endonasal dacryocystorhinostomy (DCR), but as yet poorly studied. Aim -to perform morphological study of reparative processes at osteotomy site after endoscopic endonasal DCR. Material and methods. The study included 18 patients (18 women) aged 62.59±10.07 years with nasolacrimal duct obstruction, who underwent endoscopic endonasal DCR (P.J. Wormald modification). Osteotomy site biopsies were taken on days 2, 5, 7, 10, 14, 21, 28, and 60 after the surgery. All the samples were stained with haematoxylin and eosin. For further details on cellular composition of inflammatory infiltrate, 54 samples were also processed into semi-thin sections. The slides were then viewed under Leica DM-2500 (Leica, Germany) photomicroscope. Leica DFC320 digital camera and ImageScope Color software were used for image acquisition and analysis. Result...
Purpose: Secondary acquired lacrimal duct obstruction (SALDO) is one of the complications of radioiodine therapy. SALDO is formed a few months after therapy if there is a sufficient uptake of radioactive iodine by the nasolacrimal duct. To date, risk factors leading to SALDO are unclear. The objective was to determine the correlation between the tear production level and radioactive iodine-131 uptake in the lacrimal ducts. Methods: Basal and reflex tear production was studied in 64 eyes prior to the therapy with radioactive iodine-131 after drug-induced hypothyroidism. The condition of the ocular surface was assessed using the Ocular Surface Disease Index (OSDI) questionnaire. Seventy-two hours after the radioactive iodine therapy, scintigraphy was performed, which determined the presence or absence of iodine-131 in the lacrimal ducts. T-statistics and the Mann–Whitney criterion were used to identify the differences between the groups. The differences were considered significant at P ≤ 0.05. The current tear production level in patients receiving radioiodine therapy was determined using a mathematical model. Results: A statistically significant difference between the basal ( p = 0.044) and reflex ( p = 0.015) tear production levels was found in cases with and without iodine-131 uptake by the lacrimal ducts. The probable current tear production level corresponds to the sum of basal and 10–20% of reflex tear production. The uptake of iodine-131 was found regardless of the OSDI results. Conclusion: The probability of iodine-131 uptake by the lacrimal ducts rises as the tear production level increases.
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