CHARACTERISTICS OF ACQUIRED OBSTRUCTION OF LACRIMAL PATHWAYS IN PATIENTS WITH CHRONIC TYPE 2 DIABETES AND COMBINED CONSERVATIVE AND SURGICAL TREATMENT INVOLVING ENT SPECIALISTS
Authors: Bezega N.M 
Published: December 2023

Pathological changes in the lacrimal system such as dry eye syndrome in patients with diabetes are well described in modern literature, but no sufficient attention is paid to the problem of the lacrimal system in this group of patients. Currently, the established protocol for treating chronic dacryocystitis involves collaborative endoscopic endonasal dacryocystorhinostomy conducted by ophthalmic surgeons and ENT specialists. However, in patients with type 2 diabetes, there is a need to investigate the clinical effectiveness of this surgical approach.

Purpose of this study is to evaluate the effectiveness of conservative and surgical treatment in patients with chronic dacryocystitis depending on the presence of type 2 diabetes and to determine the features of the postoperative period.

Materials and methods. The study included 30 patients with chronic dacryocystitis and type 2 diabetes (main group) and 30 patients with chronic dacryocystitis without diabetes (control group), who underwent endoscopic endonasal dacryocystorhinostomy according to the standard technique. The results of the operation were evaluated in 2 months, 6 months and 2 years following the surgical interventions.

Endoscopic endonasal dacryocystorhinostomy was considered as an effective technique for restoring unobstructed lacrimal drainage when it lead to the alleviation of tearing, and preventing re-infection of the lacrimal sac. Alongside conventional ophthalmological examinations, the assessment involved nasopharyngeal and lacrimal suction tests, reflux tests, lacrimal duct lavage, lacrimal canal probing, computer tomography, and endoscopic examination of the nasal cavity.

Results and discussion. The effectiveness of surgical treatment in 2 months after the operation in patients of the main group (70% of patients) was 1.3 times, after 6 months (63.3% of patients) was 1.4 times, and in the remote period in 2 years (50% of patients) was 1.6 times lower than in patients of the control group (р<0.05). Analyzing the presence of the main symptoms of chronic dacryocystitis in the dynamics of observation, it was noted that after endoscopic endonasal dacryocystorhinostomy the most frequent symptom was lacrimation, but its frequency in patients of the main group after 2 months (30% of patients) was 4.5 times, after 6 months (36.7% of patients) - 2.8 times, after 2 years (50% of patients) - 2.5 times higher than in patients of the control group (р<0.05 ).

The efficacy of surgical treatment's in 2 month following the operation in the main group patients (70%) was 1.3 times, after 6 months (63.3%) was 1.4 times, and in the long-term, 2 years post-operation (50%), was 1.6 times lower than in the control group patients (p<0.05). Analyzing the dynamics of chronic dacryocystitis symptoms during observation, it was observed that following endoscopic endonasal dacryocystorhinostomy, lacrimation emerged as the most common symptom. However, its frequency in the main group patients was notably higher after 2 months (30%), being 4.5 times, after 6 months (36.7%) it was 2.8 times higher, and after 2 years (50%) it was 2.5 times higher compared to the control group (p<0.05).

Conclusions. In patients with type 2 diabetes, the clinical effectiveness of conservative and surgical treatment for chronic dacryocystitis is lower than in patients without diabetes, and the postoperative period has its own characteristics.