Цель исследования -разработка метода изучения особенностей строения устья носослезного протока по данным многосрезовой компьютерной томографии (МСКТ).Материал и методы. Изучено строение устья носослезного протока у 65 человек (96 случаев), в том числе у здоровых добровольцев (29 случаев), пациентов с дакриостенозом (45 случаев) и с односторонним дакриоциститом (22 случая). Определение типа устья носослезного протока проводили по разработанной методике на основе данных МСКТ слезоотводящих путей с контрастированием. Для верификации во всех случаях применяли ретроградное зондирование носослезного протока. Результаты. Определено четыре возможных типа строения устья носослезного протока. Несоответствие типа устья носослезного протока по данным МСКТ типу, установленному при ретроградном зондировании, обнаружено в 5 случаях. Точность разработанной методики определения типа строения устья носослезного протока составила 94,8%. Заключение. Разработанная методика, основанная на МСКТ, неинвазивна, позволяет достоверно определить тип строения устья носослезного протока и может быть включена в алгоритм обследования пациентов с нарушениями слезоотведения. Ключевые слова: слезоотводящие пути; устье носослезного протока; многосрезовая компьютерная томография. Для цитирования: Атькова Е.Л., Ярцев В.Д., Краховецкий Н.Н., Резникова Л.В., Роот А.О. Изучение особенностей строения устья носослезного протока по данным многосрезовой Objective. To develop a method for investigating the perculiarities of the structure of the nasolacrimal duct orifice according to the data of multislice computed tomography (MSCT).Material and methods. The structure of the nasolacrimal duct orifice was investigated in 96 cases in 65 people, including healthy volunteers (n = 29), patients with dacryostenosis (n = 45), and those with unilateral dacryocystitis (n = 22). The type of the nasolacrimal duct orifice was identified using the developed procedure on the basis of the data of contrast-enhanced MSCT of the lacrimal passages. For verification, the investigators used retrograde probing of the nasolacrimal duct in all cases.Results. There were four possible types of the structure of the nasolacrimal duct orifice. Five cases showed discordance between the type of nasolacrimal duct office and the MSCT type identified by retrograde probing. The accuracy of the developed procedure to identify the type of the nasolacrimal duct orifice was 94.8%. Conclusion.The developed methodology based on CT is noninvasive, can reliably identify the type of the structure of the nasolacrimal duct orifice, and may be included in the algorithm for examination of patients with lacrimation disorders.Index terms: lacrimal passages; opening of the nasolacrimal duct; multislice computed tomography.
Основной причиной неудачного исхода хирургического лечения хронического дакриоцистита является рубцевание вновь образованного искусственного соустья — дакриостомы. Данный исход обусловлен продолжающейся активностью миофибробластов, приводящей к формированию грубого рубца. Среди лекарственных средств предотвращения рубцевания в настоящее время наибольшую распространенность получил противоопухолевый антибиотик митомицин С. Тем не менее противоречивые данные об эффективности этого препарата обусловливают необходимость его изучения, а также поиска альтернативных лекарственных средств, способных предотвратить рубцевание. За последние годы достигнуты определенные успехи в создании новых антифибротических препаратов, относящихся к группам моноклональных антител, малых молекул РНК и других средств генной терапии, наночастиц и низкомолекулярных препаратов. В настоящем обзоре представлены имеющиеся сведения об эффективности данных препаратов, а также о перспективах их применения в дакриологии.
Introduction. Primary angle-closure glaucoma (PACG) remains one of the leading causes of irreversible blindness. Up to date, a significant amount of data has been accumulated concerning the biometric parameters of the eye in PACG, however, there is a lack of information on the dynamic characteristics of these parameters.Objective: to evaluate the dynamic biometric characteristics of the structures of the anterior segment of the eye in PACG.Patients and methods. The results of optical coherence tomography were analyzed in 40 patients with PACG and in 40 patients without signs of hydrodynamic disorder. The studies were carried out under photopic and mesopic illumination conditions. The scanned images were obtained using an RTVue-100-2 optical coherence tomograph device (Optovue, USA). Biometric measurements were performed using standard tomograph software; volumetric studies were carried out based on the Pappus-Guldinus theorem with additional constructions. When analyzing the obtained images, 13 different linear and volumetric parameters were evaluated.Results. A decrease in the parameters reflecting the features of the configuration of the anterior chamber of the eye was noted in the presence of PACG (width of the ACA, depth and volume of the anterior chamber). From the point of view of the possible influence on the state of the anterior chamber angle, it is necessary to highlight changes in such indicators as the area, volume and thickness of the iris. Regardless of the conditions of the examination, these indicators, on average, were significantly higher in the PACG and practically did not change with a decrease in the level of illumination. At the same time, in the absence of disturbances in hydrodynamics under mesopic conditions, despite an increase in the thickness of the iris, a significant decrease in its area and volume was noted.Conclusion. Biometric changes in the structures of the anterior segment of the eye in the case of PACG relate not only to linear, but also to volumetric indicators. As a certain component of hydrodynamic disorders in the case of PACG, the revealed preservation of the iris volume during pupil dilation under mesopic illumination conditions should be considered, while in the absence of hydrodynamic disorders, this indicator decreased. Therefore, not only static changes in the biometric characteristics of the structures of the anterior segment of the eye, but also their dynamic fluctuations, should be considered as a risk factor for clinical manifestations of PACG, which determines the practical significance of dynamic biometric studies in the examination of patients with suspected PACG.
In recent years, the use of chemotherapeutic agents in the treatment of cancer became more common. At the same time, the number of complications associated with this is also increasing. Among the rare complications of therapy with some antitumor drugs is the formation of secondary acquired nasolacrimal duct obstruction. The aim was to analyze and systematize information about secondary acquired nasolacrimal duct obstruction due to the toxic effect of antitumor drugs. Materials and methods. The authors analyzed the literature available in the MEDLINE and RSCI search engines in February 2021. The analysis included 55 publications. Results. In the literature, there are indications that such antitumor drugs as 5-fluorouracil and similar drugs, mitomycin C, as well as therapy with radioactive iodine, are characterized by the possibility of developing complications in the form of secondary acquired nasolacrimal duct obstruction. Preliminary screening of the drainage function of the tear ducts, as well as prescribing of local anti-inflammatory and antibacterial treatment in the form of instillations in the conjunctival sac can help to reduce the risk of complications. This explains the need to recommend patients to consult an ophthalmologist if there are relevant complaints before or during treatment. In the absence of timely treatment, obstruction of the tear ducts often becomes an indication for reconstructive interventions. Conclusion. Secondary acquired nasolacrimal duct obstruction is one of the rare, but systematically occurring complications of antitumor therapy. To date, the pathogenesis of these complications is not fully understood, and some of the data is contradictory. In the future, the accumulation of knowledge concerning the pathogenesis of this complication will contribute to the development of personalized methods of prevention.
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