摘要目的 探讨手术显微镜下应用小梁咬切器行泪点咬切成形和联合双泪小管置管术治疗泪点膜覆盖及泪点膜闭的效果.方法 36例(48眼)泪点膜覆盖和泪点膜闭,按照泪点膜的基底部占泪点口径圆周的范围由小到大分为4组,第1组8例(9眼),采用小梁咬切器在显微镜下行单纯泪点咬切成形术;第2组16例(23眼);第3组7例(9眼);第4组5例(7眼).第2、3、4组采用小梁咬切器咬切成形联合双泪小管人工泪管置管术.3个月后拔除人工泪管,拔管后随访6 ～12个月.结果 4组均取得了较为良好的效果,溢泪症状完全消失者30例(42眼),占87.5％;好转4例(4眼),占8.3％;无效2例(2眼),占4.2％.其中第1组治愈7例(8只眼),占88.8％,好转1例(1眼),无无效病例.第2、3、4组共治愈24例(34眼)占87.1％,好转各组1例(1眼)共3例(3眼),第3组、第4组无效各1例(1眼).结论 手术显微镜下应用小梁咬切器行泪点咬切成形术和必要时联合双泪小管人工泪管置管术是治疗泪点膜覆盖及泪点膜闭的一种损伤小、疗效好、成功率高的方法.

abstractsObjective To evaluate the efficiency of microsurgical punctoplasty by using trabeculectomy punch or combined with bicanalicular stent intubation in patients with punctal membranes.Methods 36 patients (48 eyes) with partial or entire punctal membranes were distributed into 4 groups based on the proportion of basal part of the membrane to the circumference of lacrimal punctum from small to big.Group 1 (8 patients,9 eyes) underwent a microsurgical punctoplasty using a trabeculectomy punch,while group 2 (16 patients,23 eyes),group 3 (7 patients,9 eyes),and group 4 (5 patients,7 eyes) underwent a punctoplasty combined with insertion of self-retaining bicanalicular stents.These tubes were removed at 3 months after the operation.A follow-up of 6 to 12 months was taken for final analysis.Results Of all the four groups,30 patients (42 eyes,87.5％) had complete epiphora relief,4 patients (4 eyes,8.3％) had partial relief and 2 patients (2 eyes,4.2％) had no improvement after the removal of the tubes.In group 1,complete resolution of symptoms and signs was noted in 7 patients (8 eyes,88.8％),and there was no ineffective case but 1 patient (1 eye) of partial relief.While in group 2,3 and 4,24 patients (34 eyes,87.1％) had complete relief from epiphora,1 patient (1 eye) of each group had partial relief,and 1 patient (1 eye) of group 3 and group 4 respectively had no improvement after the procedure.Conclusion Microsurgical punctoplasty by using trabeculectomy punch or combined with bicanalicular stent intubation when necessary can be an effective and minimally invasive treatment for punctal membrane.