Comparison of digital subtraction dacryocystography and dacryoendoscopy in patients with epiphora
Comparison of digital subtraction dacryocystography and dacryoendoscopy in patients with epiphora
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DOI：
10.1038/s41433-020-0990-1
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发表时间：
2020-05-28
期刊：
影响因子：
3.9
通讯作者：
Lee, Jeong Kyu
中科院分区：
文献类型：
--
作者：
Bae, Seon Ha;Park, Juwan;Lee, Jeong Kyu
目的评价数字减影泪囊造影（DCG）和泪囊内窥镜检查对泪溢的诊断价值。方法对34例泪溢患者的68个泪道系统进行前瞻性研究。患者首先行眼底检查，然后行数字减影动态心电图和泪道内窥镜检查以明确诊断。泪道阻塞的程度，位置和原因进行了评价。加权kappa系数用于比较试验之间的一致性。结果在68例泪道阻塞中，超声心动图、动态心电图和泪道内窥镜检查分别发现56例（82.3%）、38例（55.9%）和60例（88.2%）泪道阻塞。68条泪道中42条（61.8%）的DCG与泪道内窥镜检查结果一致。DCG和泪管内窥镜检查的加权Kappa值为0.60（95% CI：0.40-0.81）。泪道内窥镜检查中阻塞部位以总泪小管（36.7%）和鼻泪管（28.3%）最多见。33条泪道（48.5%）在DCG和泪道内窥镜检查之间被确定为在同一水平上有阻塞。动态心电图检查正常的30条泪道中，22条泪道阻塞，其中11条位于总泪小管。泪道内窥镜检查提供了关于阻塞原因和多个阻塞部位识别的其他有用信息。结论动态心电图与泪道内窥镜检查对泪道阻塞的诊断具有一定的一致性。泪道内窥镜检查允许对泪道进行全面的调查，并有助于解释与泪溢患者泪道阻塞相关的不明因素。
Objective To assess the diagnostic information provided by digital subtraction dacryocystography (DCG) and dacryoendoscopy in patients with epiphora. Methods Sixty-eight lacrimal systems of 34 patients with epiphora were prospectively studied. Patients were initially examined with syringing, followed by digital subtraction DCG and dacryoendoscopy to confirm the diagnosis. Obstructions in lacrimal pathways were evaluated by degree, location, and cause. The weighted kappa coefficient was used to compare the agreement between the tests. Results Of the 68 lacrimal pathways, partial or complete obstructions were identified in 56 cases (82.3%) with syringing, in 38 cases (55.9%) with DCG, and in 60 cases (88.2%) with dacryoendoscopy. DCG and dacryoendoscopy showed the same result in 42 of the 68 (61.8%) lacrimal pathways. The weighted kappa value for DCG and dacryoendoscopy was 0.60 (95% CI: 0.40-0.81). The most common sites of obstruction were the common canaliculus (36.7%) and the nasolacrimal duct (28.3%) in dacryoendoscopy. Thirty-three lacrimal pathways (48.5%) were identified to have obstructions on the same level between DCG and dacryoendoscopy. Among the 30 lacrimal pathways (44.1%) that were normal by DCG, obstruction was revealed in 22 cases by dacryoendoscopy, with 11 cases in the common canaliculus. Additional useful information on the cause of obstruction and identification of multiple obstructed sites was provided by dacryoendoscopy. Conclusions DCG and dacryoendoscopy showed moderate agreement in detecting lacrimal pathway obstruction. Dacryoendoscopy allowed for comprehensive investigations of the lacrimal pathway and can help explain unidentified factors associated with lacrimal pathway obstruction in patients with epiphora.