Objective: To investigate the clinical efficacy of wound exclusion combined with silicone tube bicanalicular intubation for treatment of pigmented nevi of the lacrimal punctum. Methods: A retrospective case series analysis was conducted. Clinical data were collected from patients with pigmented nevi of the lacrimal punctum who underwent wound exclusion combined with silicone tube bicanalicular intubation at the Ophthalmology Center of Zhejiang Provincial People's Hospital from April 2020 to February 2023. During the surgery, a linear silicone tube was annularly placed to support the punctum and lacrimal canaliculus under local anesthesia, followed by the pigmented nevus excision under a surgical microscope. The linear silicone tube was removed at 4 to 6 weeks postoperatively. The duration of surgery and postoperative recovery status were recorded and summarized, including the recurrence of the pigmented nevus, epiphora, shape and position of the punctum, medial canthal morphology, and local scar condition. Results: This study included a total of 15 patients, 5 males and 10 females, with an average age of (47.7±13.5) years (range, 19 to 65 years). Two patients had pigmented nevi of the upper punctum, and 13 had pigmented nevi of the lower punctum. All nevi grew around the punctum and were completely excised during the surgery, which lasted (21.8±2.4) minutes on average. By 2 weeks postoperatively, all wounds healed with conjunctivalization, and new punctum openings formed. By 4 to 6 weeks postoperatively, the eyelid margin morphology was almost normal, when the linear silicone tube was removed. The follow-up ranged from 6 months to 2 years. No recurrence of the pigmented nevus was observed during the follow-up. The puncta were well formed without the symptom of epiphora, the medial canthal morphology was basically symmetrical to the healthy side, and the eyelid margin scars were inconspicuous, with a satisfactory appearance. No complications such as punctal occlusion, trichiasis, entropion, and ectropion occurred. Conclusions: For exophytic pigmented nevi of the punctum that do not deeply involve the lacrimal canaliculus, using the wound exclusion combined with silicone tube bicanalicular intubation during the nevus excision may reduce surgical trauma. This simple and feasible method can achieve good therapeutic effects and cosmetic outcomes.
目的: 探讨创面旷置法联合泪道置管治疗泪点色素痣的临床疗效。 方法: 回顾性病例系列研究。收集2020年4月至2023年2月在浙江省人民医院眼科诊断为外生型泪点色素痣并采用创面旷置法联合泪道线性硅胶管环形置管治疗的患者资料。手术中局部麻醉后行泪道线性硅胶管环形放置支持泪点和泪小管,于手术显微镜下切除色素痣,创面旷置,术后4~6周拔除泪道线性硅胶管。记录并总结手术时长和术后恢复情况,包括泪点色素痣复发情况,溢泪情况,新泪点形态、位置,内眦形态,局部瘢痕情况等。 结果: 本研究共纳入患者15例,其中男性5例,女性10例;年龄为(47.7±13.5)岁,范围为19~65岁。2例为单眼上泪点色素痣,13例为单眼下泪点色素痣。所有色素痣均围绕泪点生长,一期完整切除,手术时长为(21.8±2.4)min。术后2周,创面均一期愈合结膜化,新泪点开口成形;术后4~6周,睑缘形态接近正常,拔除泪道线性硅胶管;随访6个月至2年,期间未见色素痣复发,新泪点形成良好,无溢泪症状,内眦形态与健侧基本对称,睑缘瘢痕不明显,外观满意,无泪点闭锁、倒睫、睑内翻、睑外翻等并发症发生。 结论: 对于累及泪小管浅层的外生型泪点色素痣,切除色素痣手术中采用创面旷置联合泪道线性硅胶管环形放置,可减小手术创伤,且方法简单易行,疗效确切,并可获得满意的外观效果。.