Functional endoscopic sinus surgery (FESS) is an effective and safe surgical technique, which revolutionized the surgical management of nasal cavity and paranasal sinus diseases. The intimate connection between paranasal sinuses and the orbit places the orbital content at a risk of injury during sinus surgery, especially that of ethmoid sinuses. The orbit, the optic nerve, extraocular muscles and the lacrimal drainage system could be damaged during FESS. The risk of injury correlates to anatomical variations, degree and severity of disease, previous procedure results, and surgical experience. Ophthalmic complications can vary in severity from minor ones, such as localized hematomas, to extremely dangerous, such as optic nerve injury, that could lead to complete blindness. In order to minimize the risk of such complications, it is necessary to consider probable anatomic variations of paranasal sinuses and orbit, which are to be detected by CT scan before surgery.

1 Кафедра оториноларингологии Первого Санкт-Петербургского государственного медицинского уни-верситета имени акад. И.П. Павлова; 2 Кафедра офтальмологии Первого Санкт-Петербургского государственного медицинского университета имени акад. И.П. Павлова Статья принята к печати: 25.02.2016 * В настоящее время известно множество способов диагностики патологии слёзоотведения. Усо-вершенствование методов лучевой диагностики необходимо для выбора оптимальной лечебной тактики у пациентов данной категории. Авторы предлагают разработанный ими лучевой метод диагностики нарушений оттока слезы -конусно-лучевая компьютерная томография (КЛКТ) око-лоносовых пазух (ОНП) с одновременным контрастированием слёзоотводящих путей (СОП). Разра-ботан алгоритм анализа полученных результатов. Данные оценки состояния СОП по данным КЛКТ с контрастированием у 53 пациентов позволили определить уровни стеноза СОП, особенности строения стенок слёзного мешка, носослёзного канала, а также влияние особенностей анатоми-ческих структур полости носа и ОНП на развитие данного патологического процесса в СОП, что в дальнейшем определило оптимальную лечебную тактику. Вывод: данный метод является высоко-информативным, экономически выгодным с низкой лучевой нагрузкой и возможностью проведения серий повторных обследований пациентов с патологией слёзоотводящего аппарата, что, следова-тельно, может помочь врачу в постановке правильного диагноза и определении оптимальной так-тики лечения.* Ключевые слова: конусно-лучевая компьютерная томография (КЛКТ); контрастное вещество; слёзоотводящие пути (СОП); околоносовые пазухи (ОНП); дакриоцистит; лазерная дакриоцистори-ностомия (ЛДЦРС). CONE-BEAM COMPUTERIZED TOMOGRAPHY USE FOR DETERMINATION OF OPTIMAL TREATMENT TACTICS IN PATIENTS WITH TEAR DRAINAGE SYSTEM PATHOLOGY CONDITIONS©

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The article is dedicated to the 125th anniversary of Professor E.E. Andrezen’s birth. Authors describe his life’s journey, scientific and pedagogic activities. (For citation: Astakhov YuS, Reytuzov VA, Orudzhova AB, et al. Professor E.E. Andresen 125th anniversary. Ophthalmology Journal. 2017;10(3):91-95. doi: 10.17816/OV10391-95).

The pathology of upper lacrimal pathways associated with cicatrical strictures and obliteration, anatomical features of this zone is an essential problem of epiphora occurrence. The diseases of nasal cavity and paranasal sinuses play a significant role in the etiopathogenesis of this kind of epiphora. The search of new methods of preventing or eliminating epiphora, also caused by rinological pathology, is reasonable. Aim: To estimate the efficacy of drainage implant HEALAFLOW (Aptissen, Switzerland) in patients with complains on epiphora and concomitant nasal cavity pathology. Material and methods. 29 patients (50 eyes) with complains on permanent (more than 6 months) epiphora were under the supervision. Ge nerally accepted ophthalmological, dacryological, rhinological examinations, including cone-ray computer tomography of the paranasal sinuses with preliminary contrast of the lacrimal pathways were carried out. Patients were divided into two groups. 15 people (28 eyes) composed the main group (I). 14 people (22 eyes) formed a control group (II). In I group the drainage implant HEALAFLOW (Aptissen, Switzerland) was inserted in 1 day after operation aimed on elimination of nasal cavity pathology. Patients of the II group instillation of Tobradex according to the scheme and moistening drops were prescribed. Results. According to dacryological examination 29 patients (50 eyes) with complains on epiphora had normal passive lacrimal pathway passablness, but delayed or negative results of probes characterizing active passablness. All 29 patients had a rhinological pathology, which was eliminated by the otorhinolaryngologist with the operation at the first stage. In I group 9 patients noticed an increased epiphora immediately after the administration of HEALAFLOW in lacrimal pathway, which lasted during the first 24 hours after the procedure. Based on the results of the follow-up examination, after 3 months, all patients showed an improvement, expressed in the absence or decrease of epiphora. It should be noted that in the I group (after the insertion of the implant) the positive effect was more expressed. In the I group 12 of 15 patients didn’t have epiphora and in 3 patients it decreased. In the II group — 7 patients didn’t have epiphora and in 6 patients it decreased. Conclusion. Insertion of drainage implant HEALAFLOW in the lacrimal pathway after elimination of rhinological pathology in patients with complains on epiphora is safe, well tolerated and produces a positive drainage effect. This allows to recommend the implant to patients with tear-off device abnormality in the complex treatment of tear outflow disorders.