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Journal of Personalized Medicine Mar 2024Anti-glaucoma eye drops have been investigated due to their production of fibrotic changes on the conjunctival surface, undermining the functioning of the upper lacrimal...
BACKGROUND
Anti-glaucoma eye drops have been investigated due to their production of fibrotic changes on the conjunctival surface, undermining the functioning of the upper lacrimal drainage system. We aimed to assess whether these effects may impair the effectiveness of endoscopic endonasal dacryocystorhinostomy (EE-DCR).
METHODS
This is a single-center observational retrospective study on EE-DCR via a posterior approach. Resolution of epiphora and dacryocystitis were analyzed after 1 (T1) and 6-months (T2) from surgery. Surgical success was defined as anatomical (patency at irrigation, no recurring dacryocystitis) or complete (zeroing of Munk score).
RESULTS
Twenty patients (32 sides) were enrolled. Preoperatively, 93.75% ( = 30/32) presented severe (Munk 3-4) epiphora and 68.75% ( = 22/32) recurrent dacryocystitis. At T1, 50.0% ( = 16/32) were referred with residual epiphora (Munk ≥ 1) and 18.75% ( = 6/32) dacryocystitis. At T2, 31.25% ( = 10/32) still complained of epiphora (Munk ≥ 1) and 6.25% ( = 2/32) dacryocystitis. Difference of outcomes at aggregate and paired timepoints (except for T1 versus T2) resulted in statistical significance ( < 0.05). At T2, 22 (68.75%) complete, 8 (25.0%) anatomical successes and 2 (6.25%) surgical failures were observed.
CONCLUSIONS
Despite the chronic uptake of anti-glaucoma eye drops, EE-DCR guaranteed high rates of clinical relief from epiphora and remarkable decreases in the rates of recurrent dacryocystitis.
PubMed: 38672975
DOI: 10.3390/jpm14040348 -
Medicine Mar 2024This article aimed to discuss the efficacy and safety of endoscopic dacryocystorhinostomy (EDCR) versus external dacryocystorhinostomy (EX-DCR) for the treatment of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This article aimed to discuss the efficacy and safety of endoscopic dacryocystorhinostomy (EDCR) versus external dacryocystorhinostomy (EX-DCR) for the treatment of dacryocystitis by meta-analysis.
METHODS
All randomized controlled trials that met the inclusion and exclusion criteria were collected by searching the following databases: PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang, from the establishment of the database to June 2023. Meta-analysis was performed using Stata 17.0 software and review manager 5.4 software. In the collected trials, the observation group was treated with EDCR, whereas the control group was treated with EX-DCR.
RESULTS
A total of 10 studies involving 969 patients were included in this analysis. There was a similar surgical success rate in the treatment of dacryocystitis between the 2 groups (RR = 1.021, 95% CI [0. 803, 1.297], P = 0. 865). However, compared with the control group, patients in the observation group had a higher total effective rate of treatment (RR = 1. 195, 95% CI [1. 063, 1.343], P = .003), and shorter operative time (WMD = -23.640, 95% CI [-35.533, -11.747], P < .001), and less intraoperative blood loss (WMD = -50.797, 95% CI [-80.339, -21.255], P = .001), shorter length of hospital stays (WMD = -4.570, 95% CI [-5.992, -3.148], P < .001), and lower incidence of adverse events (RR = 0.295, 95% CI [0.173, 0.504], P < .001).
CONCLUSION
EDCR is an effective and safe surgical procedure for the treatment of dacryocystitis and can be used as an alternative to EX-DCR.
Topics: Humans; Dacryocystorhinostomy; Dacryocystitis; Blood Loss, Surgical; China; Treatment Outcome; Endoscopy
PubMed: 38489695
DOI: 10.1097/MD.0000000000037312 -
Indian Journal of Ophthalmology May 2024The prognosis of combined septoplasty and endoscopic dacryocystorhinostomy (En-DCR) for moderate nasal septum deviation (NSD) has not yet been fully investigated.
CONTEXT
The prognosis of combined septoplasty and endoscopic dacryocystorhinostomy (En-DCR) for moderate nasal septum deviation (NSD) has not yet been fully investigated.
PURPOSE
To evaluate whether septoplasty improves the prognosis of En-DCR for moderate NSD.
SETTINGS AND DESIGN
A retrospective cohort study in a real-world clinical setting.
METHODS
The postoperative FICI DCR ostium grading scores and functional and anatomical information at 1, 2, 3, and 6 months were determined for consecutive patients with chronic dacryocystitis (CD) and moderate NSD who underwent En-DCR.
STATISTICAL ANALYSIS USED
Univariate and generalized estimating equation multivariate analyses were used to compare the outcomes of the septoplasty and non-septoplasty groups.
RESULTS
En-DCR and septoplasty were concurrently performed for 32 (20.1%, 32/158) cases. The total FICI DCR ostial scores for the septoplasty and non-septoplasty groups were highest at the first (4.97 ± 0.177 vs. 4.97 ± 0.176, P > 0.05) and lowest at the sixth (4.41 ± 1.341 vs. 4.50 ± 1.355, P > 0.05) postoperative months. At the end of follow-up, the two groups showed comparable proportions of patients requiring definitive intervention for the ostium (6.3% vs. 7.1%, P > 0.05), comparabe functional success rates (87.5% vs. 90.5%, P > 0.05) and anatomical success rates (93.8% vs. 92.9%, P > 0.05). Only the non-septoplasty group experienced nasal mucosal adhesions (3.2%, 4/126).
CONCLUSIONS
In patients with CD and moderate NSD, nasal septoplasty did not impact En-DCR prognosis, but reduced the complications. Skilled surgeons should reconsider septoplasty in the absence of otolaryngological indications.
PubMed: 38454860
DOI: 10.4103/IJO.IJO_1970_23 -
Clinical Ophthalmology (Auckland, N.Z.) 2024To investigate the microbiology and antimicrobial susceptibility of dacryocystitis in adults and identify the changing trends over time in Taiwan.
PURPOSE
To investigate the microbiology and antimicrobial susceptibility of dacryocystitis in adults and identify the changing trends over time in Taiwan.
METHODS
This is a single-centered, retrospective study. We retrospectively reviewed adult patients with dacryocystitis from January 2012 to December 2021 in a tertiary medical center in Taiwan. The pathogens and in vitro antimicrobial susceptibility of the pus cultures from the lacrimal sac were collected.
RESULTS
Thirty-five cultures in acute and 211 cultures in chronic dacryocystitis were collected. Of the 220 isolates, a similar proportion of gram-positive (44%) and gram-negative (43%) aerobes were demonstrated in chronic dacryocystitis and more gram-negative aerobes (50%) than gram-positive aereobes (41%) in acute dacryocystitis. The most common pathogens were methicillin-resistant (MRSA; 28.1%) and (28.1%) in acute dacryocystitis, while coagulase-negative was the most common micro-organism in chronic dacryocystitis. The effective antibiotics for gram-positive aerobes were vancomycin (100%), moxifloxacin (88%) and trimethoprim/sulfamethoxazole (78%). Meropenem (95%), amikacin (93%), and levofloxacin (91%) were sensitive to more than 90% of gram-negative aerobes in current study. High resistant species were also isolated in our cohort.
CONCLUSION
More gram-negative pathogens and more resistant species are rising in adult dacryocystitis. Understanding the bacteriology and antimicrobial susceptibility of the region is crucial for the empirical antibiotic selection in clinical practice.
PubMed: 38414483
DOI: 10.2147/OPTH.S452707 -
The American Journal of Case Reports Feb 2024BACKGROUND Congenital eyelid coloboma in children often faces complications such as keratitis, symblepharon, and amblyopia. Repairing defects involving at least 50% of...
BACKGROUND Congenital eyelid coloboma in children often faces complications such as keratitis, symblepharon, and amblyopia. Repairing defects involving at least 50% of the eyelid margin can be challenging. Acellular dermal allograft (ADA) has achieved excellent results as a substitute in adult eye plastic surgery, with minimal morbidity. This report describes a case of reconstruction of an eyelid defect in a 7-month-old male infant using an ADA. CASE REPORT A 7-month-old male infant was referred due to congenital eyelid coloboma in the left eye, which affected nearly one-half of the upper and lower eyelids medially, with more than 9 mm of lagophthalmos and lacrimal duct malformation inducing dacryocystitis. Under general anesthesia, A U-shaped silicone drainage tube was inserted in the nasolacrimal duct to ensure an unobstructed lacrimal duct. The symblepharon release, pseudopterygium excision, and medial canthus reconstruction were performed sequentially. Then, the upper eyelid defect was repaired through the advancement of the lateral segment of the eyelid, following lateral cantholysis. A trimmed ADA was placed as a substitute for the tarsal plate in the lower eyelid defect area and sutured with the free edge of the retractor. Finally, the lower and lateral skin orbicular muscle flap was advanced to cover the acellular dermis composite graft. The postoperative eyelid morphology was satisfactory. At 6 months after surgery, lower eyelid retraction gradually appeared. CONCLUSIONS ADA is presented as an effective solution for reconstructing significant eyelid defects of infants. However, the potential of postoperative eyelid retraction still deserves future research and refinement in surgical techniques.
Topics: Adult; Child; Infant; Humans; Male; Coloboma; Treatment Outcome; Eyelids; Eyelid Diseases; Cicatrix; Allografts
PubMed: 38339775
DOI: 10.12659/AJCR.942645 -
BMC Ophthalmology Feb 2024To report the microbiological isolates, aetiology, complications, antibiotic susceptibilities, and clinical remission of dacryocystitis and canaliculitis in a prominent...
BACKGROUND
To report the microbiological isolates, aetiology, complications, antibiotic susceptibilities, and clinical remission of dacryocystitis and canaliculitis in a prominent tertiary ophthalmic teaching and referral hospital located in northern China and to offer appropriate recommendations for preventing and formulating drug treatment strategies.
METHODS
This prospective study recruited a total of 477 participants who had been diagnosed with either dacryocystitis or canaliculitis. The cohort comprised 307 patients with chronic dacryocystitis, 111 patients with acute dacryocystitis, and 59 patients with canaliculitis. Purulent discharge from the lacrimal duct was collected using a sterile swab and immediately subjected to microbial culture. Antimicrobial susceptibility testing was conducted following established protocols. All participants were scheduled for follow-up visits within 14 days after receiving antibiotic therapy.
RESULTS
The present findings indicated that women exhibited a higher susceptibility to the condition, as evidenced by the occurrence of 367 cases in comparison to 110 cases among men. Among the 477 patients, definitive causes were established in 59 individuals, accounting for 12.4% of the patients. Additionally, ocular complications were reported by 132 patients, representing 27.7% of the total. Monocular involvement was observed in the majority of cases, with 402 out of 477 patients (84.3%) affected, while binocular involvement was present in 75 patients (15.7%). In total, 506 microbiological strains were recovered from 552 eyes, with Staphylococcus epidermidis (16.4%) being the most prevalent microorganism. Other predominant isolates included Corynebacterium macginleyi (9.1%), Staphylococcus aureus (5.1%), Streptococcus pneumoniae (4.9%), Haemophilus (4.4%), Propionibacterium acnes (3.5%), and Eikenella corrodens (3.1%). Among the 12 isolated fungi, Candida parapsilosis accounted for 66.7%. The susceptibility to antimicrobial agents tested in gram-negative bacilli (79.5%) was observed to be higher than that of anaerobic bacteria (76.7%) and gram-positive cocci (55.4%). With pharmacological therapy, the remission rate of acute dacryocystitis (72.7%) was found to be higher than that of canaliculitis (53.3%) and chronic dacryocystitis (42.3%).
CONCLUSIONS
This study highlights the microbial spectrum of dacryocystitis and canaliculitis, particularly C.macginleyi, E.corrodens and C.parapsilosis, which are also more frequently isolated. Vancomycin and imipenem may be more effective treatment options. Most cases have an unknown aetiology, and essential preventive measures involve postoperative cleansing of the lacrimal passage following eye and nasal surgeries, as well as the proactive management of rhinitis.
Topics: Male; Humans; Female; Canaliculitis; Prospective Studies; Dacryocystitis; Lacrimal Apparatus; Anti-Bacterial Agents; Hospitals, Teaching
PubMed: 38317063
DOI: 10.1186/s12886-024-03323-x -
Internal Medicine (Tokyo, Japan) 2024A 48-year-old woman visited our hospital because of bilateral lacrimal gland enlargement. Her serum immunoglobulin G4 (IgG4) level was high, and positron emission...
A 48-year-old woman visited our hospital because of bilateral lacrimal gland enlargement. Her serum immunoglobulin G4 (IgG4) level was high, and positron emission tomography-computed tomography showed significant positive findings in the bilateral lacrimal gland. A biopsy revealed a considerable increase in IgG4/CD138, leading to a diagnosis of IgG4-related dacryoadenitis. The disease did not respond to steroid therapy, so treatment was started with baricitinib because of exacerbation of the original atopic dermatitis and dacryoadenitis after the second dose of the coronavirus disease 2019 (COVID-19) vaccine. Baricitinib was effective for resolving both dermatitis and dacryoadenitis, and steroids were able to be discontinued. The IgG4 level also improved.
Topics: Female; Humans; Middle Aged; Azetidines; Biopsy; Dacryocystitis; Immunoglobulin G; Lacrimal Apparatus; Purines; Pyrazoles; Sulfonamides
PubMed: 38296523
DOI: 10.2169/internalmedicine.1862-23