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Behandlung kindlicher Tränenwegsstenosen

Eine prospektive klinische Kohortenstudie

Treatment of congenital lacrimal duct obstruction

A prospective clinical cohort study

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An Erratum to this article was published on 17 November 2015

Zusammenfassung

Hintergrund

Die Überdruckspülung der ableitenden Tränenwege (TNW) bei angeborener Tränenwegsstenose stellt noch immer die Therapie der Wahl nach Scheitern konservativer Maßnahmen dar. Ziel war es, verschiedene therapeutische Optionen hinsichtlich ihrer Wirksamkeit in Abhängigkeit vom Lebensalter zu bewerten.

Material und Methoden

Anhand einer prospektiven klinischen Kohortenstudie wurden alle Kinder, die aufgrund einer konnatalen Dakryostenose im Zeitraum Mai 2009 bis Juni 2010 behandelt wurden, eingeschlossen. Als Therapieerfolg wurde das Fehlen von Epiphora und mukopurulenter Sekretion nach 3 Monaten postoperativ definiert. Die Berechnung der Effektstärken verschiedener Einflussfaktoren wurde mittels logistischer Regression durchgeführt.

Ergebnisse

Es wurden 111 Kinder (137 Augen) behandelt. Das mittlere Lebensalter betrug 7,7 Monate (Altersspanne 1 bis 30 Monate). In 85,5 % (n = 100) konnte eine Heilung durch Überdruckspülung in Lokalanästhesie erreicht werden. Eine Überdruckspülung in Allgemeinanästhesie ohne Einbringen von Silikonstützmaterial führte in 28,6 % (n = 2) zur Heilung. Durch eine Überdruckspülung in Allgemeinanästhesie mit Einbringen von Silikonstützmaterial wurden 34 von 35 TNW (94,2 %) erfolgreich behandelt. Die OR bei primär kompliziertem Verlauf der Behandlung betrug 1,9 [95 %-Konfidenzintervall (KI): 0,7–5,1], die für männliches Geschlecht 1,7 (95 %-KI: 0,8–3,5) und bei positiver Familienanamnese 1,5 (95 %-KI: 0,7–3,3). Pro Anstieg um 1 Lebensmonat stieg das Risiko einer erfolglosen Behandlung um das 1,3-Fache (Odds Ratio: 1,3, 95 %-KI: 1,2–1,5).

Schlussfolgerung

Die Überdruckspülung in Lokalanästhesie ist eine effektive Therapie. Die höchsten Heilungsraten wurden in den Altersgruppen von 1 bis 6 Monaten beobachtet. Behandlungen mit zusätzlichem Einbringen von Silikonstützmaterial erzielten sehr hohe Heilungsraten.

Abstract

Background

Pressurized probing and irrigation is the method of choice for congenital lacrimal duct obstruction after conservative therapeutic strategies have failed. The aim of this study was to evaluate age dependence and success rates of different therapeutic options.

Material and methods

A prospective cohort study of children with congenital lacrimal duct obstruction was performed. All children treated during the period between May 2009 and June 2010 were included. Surgical success was defined as the absence of epiphora and mucous discharge for a postoperative follow-up of 3 months. Odds ratios (OR) and 95 % confidence intervals (CI) of different variables were estimated using logistic regression.

Results

A total of 111 children (137 eyes) underwent treatment for congenital lacrimal duct obstruction. The mean age of the children was 7.7 months (range 1–30 months). The success rate of probing under local anesthesia was 85.5 % (n = 100). Probing under general anesthesia without intubation of the lacrimal pathway was successful in 28.6 % (n = 2). Treatment under general anesthesia with intubation of the lacrimal pathway had a success rate of 94.2 %. If the primary treatment was complicated the OR was 1.9 (95 % CI: 0.7–5.1), for males the OR was 1.7 (95 % CI: 0.8–3.5) and in cases of a positive family history the OR was 1.5 (95 % CI: 0.7–3.3). With every increasing month of age the risk not to be treated successfully increased (OR: 1.3, 95 % CI: 1.2–1.5).

Conclusion

Syringing under local anesthesia is an effective therapy. The highest success rates were found at the ages of 1–6 months. Therapy with additional silicone tube intubation was highly successful.

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Authors and Affiliations

  1. Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland

    J. Heichel, F. Bachner, H.-G. Struck, U. Stuhlträger & T. Bredehorn-Mayr

  2. Institut für Medizinische Epidemiologie, Biometrie und Informatik, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland

    A. Schmidt-Pokrzywniak

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  1. J. Heichel
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  5. U. Stuhlträger
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Correspondence to J. Heichel.

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J. Heichel, F. Bachner, A. Schmidt-Pokrzywniak, H.-G. Struck, U. Stuhlträger und T. Bredehorn-Mayr geben an, dass kein Interessenkonflikt besteht.

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Heichel, J., Bachner, F., Schmidt-Pokrzywniak, A. et al. Behandlung kindlicher Tränenwegsstenosen. Ophthalmologe 112, 840–847 (2015). https://doi.org/10.1007/s00347-015-0067-x

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