高度涙小管閉塞症に対する開窓涙管チューブ長期留置術

Long-term insertion of fenestrated lacrimal-tube stent for severe canalicular obstruction

要約　目的：高度涙小管閉塞症に対し，Jonesチューブ治療に代わりうるものとして開窓涙管チューブ長期挿入術を検討した。

対象と方法：PFカテーテルの両端を切除し，開放端としたものを使用した。レーザー涙囊鼻腔吻合術後にシース誘導チューブ挿入術を用い，上下涙小管よりカテーテルを鼻腔内に留置し，カテーテル中央部をレーザーで穴を開け，開窓チューブとした。本法術後1年以上経過観察した14例17眼の成績を検討した。

結果：9例（53％）で流涙症が改善した。大きな合併症はなかった。

結論：開窓涙管チューブ長期留置術は高度涙小管閉塞症の治療に有用と考えられた。

Abstract　Purpose: To report long-term insertion of fenestratedlacrimal-tube stent for severe canalicular obstruction as substitute of Jones tube with conjunctivodacryocystorhinostomy.

Cases and Method: This study was made on 17 eyes of 14 patients who received long-term insertion of fenestrated lacrimal-tube stent for severe canalicular obstruction. The series comprised 4 males and 10 females. The age ranged from 40 to 79 years, average 66 years. A polyurethane hollow catheter was placed through the upper and lower lacrimal puncta. The catheter was fenestrated at the internal canthus by diode laser. The inserted tube was cleaned with saline once a week and was retained as long as feasible.

Results: The lacrimal tube was retained for 12 to 36 months, average 20 months. Out of 17 eyes, 9 eyes（53％）became free of lacrimation. Lacrimation persisted in the other 8 eyes. There was no case that showed severe complication.

Conclusion: Long-term insertion of fenestrated lacrimal-tube stent was effective in 53％ of eyes with severe canalicular obstruction.