The Application Of Autologous Conjunctival Transplantation In The Treatment Of Canalicular Obstruction

Objective:To investigate the application and clinical effect of autologous conjunctival transplantation combined with lacrimal duct intubation in the treatment of canalicular obstruction.Methods:A total of 23 patients(28 eyes)who were diagnosed with lacrimal canalicular obstruction and treated surgically with autologous conjunctival transplantation for reconstruction of the obstructive canaliculus at Hangzhou First People’s Hospital were collected from December 2016 to December 2020.All cases were extubated 3-6months after operation,and the efficacy of autologous conjunctival grafting combined with silicone intubation was analyzed and evaluated retrospectively during a follow-up period of at least 6 months,according to subjective symptoms and the result of lacrimal irrigation,fluorescein dye disappearance test,and lacrimal endoscopy.The influences of different obstructive locations and lengths on the prognosis of this surgical approach were also compared.Result:In all 28 cases who had autologous conjunctival transplantation surgery for canalicular obstruction,22(78.57%)were cured,with complete disappearance of epiphora and patency of lacrimal irrigation during follow-up period,3(10.71%)were improved,with significantly improved epiphora symptoms and varying degrees of canalicular narrowing,and 3(10.71%)were invalid,with no improvement or even aggravation after surgery.No serious complications were observed.All cases were divided into two groups by the average distance of 4.81 mm between the nasal end of canalicular obstruction and punctum.There were 11 cases with a distance ≥ 4.81 mm,of which 6 were cured,8 were effective,and 3 were invalid.Simultaneously,there were 17 cases with a distance < 4.81 mm,of which 16 were cured and 17 were effective,Statistical analysis showed a significant difference between the two groups(P = 0.022).All cases were further divided into two groups by the average length of the canalicular obstructive segment.There were 13 cases with a length ≥ 3.26 mm,of which 9 were cured,11 were effective,and 2 were invalid.There were 15 cases with the distance < 3.26 mm,of which 13 were cured,14 were effective,and 1 was invalid.Statistical analysis showed no significant difference between the two groups(P =0.520).The overall cure rate of this surgical approach was 78.57%(22 cases)and the effective rate was 89.29%(25 cases).Conclusions:The surgical approach that reconstructed the obstructive canaliculus using autologous conjunctival transplantation combined with lacrimal duct intubation has shown promising results in this study,with a total effective rate of 89.29% and few serious complications,making it an impactful treatment for canalicular obstruction.Patients’ subjective symptoms and the results of lacrimal irrigation,fluorescein dye disappearance test,and lacrimal endoscopy were sensitive indicators for evaluating surgical prognosis during follow-up period.According to the results of our study,the surgical outcome of obstructive obstruction treated with autologous conjunctival transplantation was related to the distance between the nasal end of canalicular obstruction and punctum,which means a long distance may lead to a worse prognosis.But the outcome was not related to the length of canalicular obstruction segment,which means good therapeutic results can be achieved even if the obstructive obstructive incision is longer when using this surgical approach for canalicular obstruction.