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Die Bedeutung bildgebender Diagnostik und interventioneller Therapie bei Erkrankungen der ableitenden Tränenwege

Importance of imaging diagnostics and interventional therapy for diseases of the lacrimal drainage canals

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Zusammenfassung

Epiphora (Tränenträufeln) wird häufig durch Obstruktionen der ableitenden Tränenwege verursacht. Die Darstellung der Tränengänge mit Kontrastmittel mit der Dakryozystographie in digitaler Subtraktionsangiographie- (DSA-)Technik ist als Goldstandard für die bildgebende Diagnostik bei Patienten mit auf konservative Therapiemaßnahmen nicht ansprechender Epiphora anzusehen. Neue Techniken wie die 3D-Rotationsdakryozystographie, MRT und CT können neben den Tränenwegen auch die anatomischen Nachbarschaftsstrukturen darstellen und insbesondere die Planung endoskopischer Operationen erleichtern. Zu den dakryozystographisch kontrollierten Interventionen zählen die Ballondilatation und die Stentimplantation. Die Ballon-Dakryozystoplastie ist insbesondere bei Patienten mit relativen Stenosen oder kurzstreckigen Verschlüssen des Ductus nasolacrimalis erfolgversprechend. Die Implantation von Kunststoffstents kann die Offenheitsrate der Tränenwege verbessern. Die interventionellen Techniken eignen sich aufgrund der im Vergleich zur offenen oder endoskopischen Operation geringen Invasivität als initiale Behandlungsmethode, haben jedoch begrenzte klinische Erfolgsraten im Langzeitverlauf. Die operative Behandlung spielt dementsprechend nach wie vor eine große Rolle. Eine vergleichende Evaluation der Therapieoptionen durch Studien ist erforderlich.

Abstract

Epiphora (continuous watering of the eyes) is frequently caused by obstruction of the lacrimal draining system. Radiographic imaging of the tear ducts after contrast injection with the DSA (digital subtraction angiography) dacryocystography technique is still the gold standard in patients with severe epiphora which does not respond to conservative therapy. Recent techniques, such as 3D rotational dacryocystography, MRI and CT are able to show the anatomic surroundings in addition to the ductal structures and are especially useful for planning endoscopic operations. Dacryocystographically assisted interventions, such as balloon dilatation or stenting of tear duct stenoses are technically feasible. Balloon dacryocystoplasty is especially successful in patients with incomplete or short distance obstructions of the nasolacrimal duct. Stenting may improve procedural success and patency rates. Minimally invasive interventional therapy is useful as an initial treatment in selected cases, however, long-term success rates may be limited and operative dacryocystorhinostomy still plays an important role. Comparative studies for evaluation of different therapeutic options are necessary.

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Authors and Affiliations

  1. Institut für Neuroradiologie, Goethe-Universität Frankfurt a.M., Schleusenweg 2-16, Haus 95, 60528, Frankfurt a.M., Deutschland

    A. Bink & J. Berkefeld

  2. Klinik für Augenheilkunde, Goethe-Universität Frankfurt a.M., Frankfurt a.M., Deutschland

    M. Lüchtenberg

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  1. A. Bink
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  2. M. Lüchtenberg
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  3. J. Berkefeld
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Correspondence to A. Bink.

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Bink, A., Lüchtenberg, M. & Berkefeld, J. Die Bedeutung bildgebender Diagnostik und interventioneller Therapie bei Erkrankungen der ableitenden Tränenwege. Radiologe 48, 1155–1160 (2008). https://doi.org/10.1007/s00117-008-1695-9

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