The dissertation work is devoted to increase the efficiency of diagnostics and treatment of pathology of nasolacrimal ducts in patients with diabetes mellitus of type 2 (DM2) on the basis of studying the clinical features of the disease. This determined the relevance of the scientific direction and the choice of the topic of the dissertation research, as well as its purpose and objectives.
To identify the features of the nasolacrimal duct pathology in DM2 patients, three studies were conducted.
The first study was conducted to identify the frequency and features of the pathology of ANDO in DM2 patients.
The second study was conducted to identify the frequency and features of symptomatic ANDO in DM2 patients.
The third study was conducted to determine the features of the operation, the postoperative period and to assess the effectiveness of EED in patients with chronic dacryocystitis depending on the presence of DM2.
As a result of the research it was found that the presence of DM2 increases the risk of nasolacrimal duct pathology: ANDO (41±4.9 % of patients) 1.4 times, complete ANDO (25±4.3 % of patients) - 1.4 times, bilateral ANDO (20±4.0 % of patients) - 1.5 times in relation to nondiabetic persons (p<0.05).
In DM2 patients clinical features of nasolacrimal duct pathology were noted, namely increase in the frequency of obstruction of the nasolacrimal duct (24±4.3% of patients) by 1.3 times, obstruction of membranous type of lacrimal puncta (9.8±3.8 % of the eyes) and punctate type (13.1±4.3 % of the eyes) 2 and 1.7 times, ANDO in women (58±7.0 % of patients) 1.5 times, blepharitis (70.7±7,1 % of patients) 1.3 times in relation to nondiabetic patients (p<0,05).
It was found that the frequency of nasolacrimal duct pathology in DM2 patients depends on the compensation of DM: the frequency of ANDO in decompensated DM (70±14.5 % of patients) is 1.4 and 2 times higher than in subcompensated and compensated DM, respectively (p<0,05); in patients with symptomatic ANDO the frequency of decompensated DM (51.8±6.7 % of patients) was 2.1 and 2.2 times higher than subcompensated and compensated DM, respectively (p<0.05).
It was found that DM2 is observed in 19.7±2.4 % of patients with symptomatic ANDO and leads to the development of the disease at a younger age: the average patients’s age is8.1 years lower than in nondiabetic patients with symptomatic ANDO (p<0,05).
In DM2 patients, clinical features of symptomatic ANDO were noted: increase in the frequency of bilateral lesions (46.4±6.7 % of patients) by 1.6 times, dacryocystitis (60.7±6.5% of patients) - by 1.5 times, obstruction of lacrimal puncta (30.3±6.1 % of patients) - 1.3 times, bilateral obstruction of lacrimal puncta (7.1±3.4 % of patients) - 2.7 times, obstruction of lacrimal puncta by membranouse type (9.8±3.3 % of the eyes) - 2 times, the dot type (9.8±3.3% of the eyes) - 1.9 times, blepharitis (71.4±6.0 % of patients) - in 1.4 times compared with the corresponding indicators of nondiabetic patients with symptomatic ANDO (p<0.05).
It was found that the increase in blood glycosylated hemoglobin HbA1c correlates with the severity of symptomatic ANDO and the presence of blepharitis in DM2 patients: complete obstruction (78.3±6.1 % of the eyes) - 1.5 times, blepharitis (79.3±7.7 %) - 1.5 times higher than the corresponding rates of patients with compensated DM2 (p<0.05).
It was found that the effectiveness of EED in patients with chronic dacryocystitis depends on the presence and degree of compensation of DM2: in DM2 patients the effectiveness of surgery after 2 months (70±8.4 % of patients) is 1.3 times, after 6 months (63.3±8,8 % of patients) - 1.4 times, after 2 years (50±9.1 % of patients) - 1.6 times lower than in nondiabetic patients (p<0.05); in patients with decompensated DM2 the effectiveness of the operation after 2 months (58.8±11.9 % of patients) is 1.4 times, after 6 months (52.9±12.1 % of patients) and 2 years (41.2 ± 11, 9% of patients) - 1.5 times lower than in patients with subcompensated and compensated DM2 (p<0.05).
It was noted that in patients with chronic dacryocystitis the frequency of squamous cell metaplasia of the superficial epithelium of the nasal mucosa depends on the presence and degree of compensation of DM2: in patients with DM2 (56.7±9.1% of patients) 1.9 times higher than in nondiabetic patients (p<0.05); with decompensated DM2 (70.6±11.1 % of patients) 1.9 times higher than that in patients with subcompensated and compensated DM2 (p<0.05).
In patients with chronic dacryocystitis and DM2 there was a correlation between squamous cell metaplasia of the superficial epithelium of the nasal mucosa and the effectiveness of EED: the frequency of metaplasia in patients with recurrence of lacrimal obstruction within 2 years (93.3±6.5 % of patients) was 4.7 times higher than in patients in whom EED was effective (p<0.05).
