Changing Bacterial Isolates and Antibiotic Sensitivities of Purulent Dacryocystitis

Purpose: To examine the current spectrum of bacterial isolates in cases of chronic dacryocystitis and dacryoabcess and to determine their antibiotic sensitivities. Materials and methods: We carried out a prospective study in which 39 patients who presented to the outpatient clinic with chronic purulent dacryocystitis or acute dacryoabscess had cultures taken. All patients were antibiotic-free for at least one week prior to culturing. Results: The 39 positive cultures grew 41 bacterial isolates, as two patients grew two species of bacteria. Sixteen isolates (39%) were Gram positive and 25 (61%) were Gram negative. The most common isolates were Pseudomonas (22%), Staphylococcus aureus (13%), Enterobacter (10%), Citrobacter (10%), Streptococcus pneumoniae, Escherichia coli, and Enterococcus (7%). Uncommon Gram-negative bacteria were also cultured: Alcaligenes in 2 cases (5%) and one case of Stenotrophomonas maltophilia (2.5%). No anaerobic bacteria were isolated. Gram-negative isolates were sensitive to ceftazidime in 95%, ciprofloxacin in 86% and cefuroxime in 50%, with a sensitivity of less than 30% to cefalexin and ampicillin in those tested.

All Pseudomonas isolates (100%) were sensitive to ceftazidime, 86% were sensitive to ciprofloxacin, while only 20% were sensitive to ampicillin and 14% to cefalexin. Alcaligenes was resistant to all antibiotics tested with the exception of ceftazidime. Conclusion: This study demonstrates a significant change in bacterial flora and antibiotic treatment requirements of purulent dacryocystitis from previously published data. A higher incidence of Gram-negative organisms, particularly Pseudomonas, with resistance to commonly used antibiotics was found. The emergence of rarer, highly resistant, Gram-negative microorganisms may also indicate a trend in lacrimal sac infections. These findings suggest that the antibiotic treatment protocol before and after lacrimal surgery should be reconsidered in this subgroup of patients.     

先天性鼻泪管阻塞致泪囊炎的病原菌及药敏结果分析

目的：分析小儿先天性鼻泪管闭塞所致泪囊炎的病原菌及其药敏结果,指导临床合理用药。 方法：对先天性鼻泪管阻塞患儿98例110眼的泪囊分泌物进行病原菌分离培养及药物敏感试验。 结果：从94眼的分泌物中共分离出155株细菌,病原菌阳性率为85.5%。其中革兰氏阳性球菌65.8%,革兰氏阴性杆菌23.9%。分离出的所有菌株对左氧氟沙星的敏感率为94.2%。 结论：药敏试验表明绝大多数细菌对左氧氟沙星有较高的敏感性,对于小儿先天性鼻泪管闭塞所致泪囊炎可给予新喹诺酮类抗生素滴眼液治疗。     

改良永久性人工鼻泪管植入术治疗慢性泪囊炎与鼻泪道阻塞

目的:探讨人工鼻泪管支架植入术的手术技巧,评价其疗效.方法:自2009/2011年选择42例42眼鼻泪管阻塞患者,在局部麻醉下,经鼻腔逆行植入永久性人工鼻泪管,术中使用带侧孔探针代替原包装中的直孔探针,通过调节探针侧孔的位置,使引导丝下端自下鼻道自行脱出,术后随访6mo,观察其临床疗效.结果:患者42例42眼成功植入人工鼻泪管,手术植入成功率100%.术后6mo进行随访,有效率100%.结论:改良永久性人工鼻泪管植入术治疗慢性泪囊炎与鼻泪道阻塞操作简单安全,疗效确切,有推广价值.     

Comparison of the success rate between monocanalicular and bicanalicular intubations in incomplete complex congenital nasolacrimal duct obstruction

This article compares the success rate between monocanalicular (MCI) and bicanalicular intubations (BCI) in incomplete complex congenital nasolacrimal duct obstruction (CNLDO) and evaluate the factors responsible for the success of intubation. First, 99 patients with incomplete complex CNLDO underwent MCI (Monoka) or BCI (Crawford). Therapeutic success was defined as dye disappearance test grade 0-1 and complete resolution of previous symptoms at 12 months’ follow-up. The success rates were compared between two groups. In all cases, the correlation of the age, gender, history of probing, and the presence of purulent discharges with the improvement in CNLDO symptoms were evaluated. 52 cases in the MCI and 47 cases in the BCI group were included. Then, 48 patients (48.5%) had history of probing. 26 patients (26.3%) had purulent discharges. The patients in the MCI group had lower success rate (59.6%) than the patients in the BCI group (74.4%) but the difference was not significant (p = 0.11). No complication occurred in the BCI group. In 4 cases (7.6%) in the MCI group, the tubes were lost before time of planned removal. In all cases, only preoperative absence of the pus was significantly correlated with success (p = 0.09 and OR = 0.39). BCI may be a better treatment for the patients with incomplete complex CNLDO. In silicone intubation for these cases, preoperative absence of purulent discharges could increase the success rate.     

成人鼻泪管阻塞探通手术及复发机制的研究进展

鼻泪管阻塞是眼科常见及多发疾病,治疗方法主要为手术治疗.近年来,随着新型材料及各种内镜技术的逐步完善,鼻泪管阻塞的治疗有了较大进展,但鼻泪管阻塞术后仍出现部分患者发生再堵,因此近年来对于鼻泪管阻塞术后复发机制的研究也逐渐增多.本文就鼻泪管阻塞各种手术治疗及复发机制进行综述.     

Prevalence of amblyopia in children undergoing nasolacrimal duct irrigation and probing

Purpose:

To investigate ambylopia and amblyopia risk factors of children who underwent nasolacrimal duct (NLD) irrigation and probing for congenital nasolacrimal duct obstruction (CNLDO).

Materials and Methods:

The medical records of patients who had undergone NLD irrigation and probing for CNLDO at an age of 3 years or younger were reviewed, and 51 of the patients were recalled between October 1 and December 31, 2011 for a detailed ophthalmic examination to determinate amblyopia or amblyopia risk factors. Amblyopia was accepted as difference in visual acuity of two or more Snellen lines between the two eyes or visual acuity of 20/30 or worse in either eye.

Results:

The median age of the 51 patients to whom NLD irrigation and probing were attempted for CNLDO was 23 months. CNLDO affected a total of 70 eyes. All patients were reviewed for best-corrected visual acuity, refractive errors, and strabismus at a median age of 70.5 months (range 31-95 months). Amblyopia or amblyopia risk factors were identified in 14 patients (27.5%). One child (7.15%) had only strabismus, six children (42.8%) had only amblyogenic refractive errors, two (14.3%) had a combination of two, one child (7.15%) had a family history for amblyopia, but four children (28.6%) had no amblyopia risk factors but had amblyopia.

Conclusion:

Amblyogenic risk factors are found higher in patients with CNLDO and patients undergoing NLD irrigation and probing in comparison to normal population. Therefore, we recommend these children to routinely undergo cycloplegic refractions and full ophthalmic examinations.     

先天性鼻泪管阻塞CT泪囊造影及骨性鼻泪管测量初步研究

目的分析先天性鼻泪管阻塞患儿CT泪囊造影检查结果,了解其骨性鼻泪管大小。设计回顾性病例系列。研究对象10例单侧先天性鼻泪管阻塞患儿。方法采用CT轴位扫描,矢状位及冠状位二维重建技术,分析10例单侧先天性鼻泪管阻塞患儿CT泪囊造影结果,并测量其双侧骨性鼻泪管直径。主要指标鼻泪管起始处、骨性鼻泪管中段及骨性鼻泪管末端平面的骨性鼻泪管横径。结果 CT可以清晰显示泪囊、鼻泪管及其周围组织。单侧先天性鼻泪管阻塞患儿阻塞侧骨性鼻泪管起始部、中部、远端的直径（5.6±1.1 mm、5.2±0.7 mm、5.8±0.7 mm）明显大于健侧（3.7±0.9 mm3、.6±0.6 mm、3.9±1.2 mm）（P均〈0.05）。结论 CT泪囊造影可以清晰显示泪道及其周围组织情况。单侧先天性鼻泪管阻塞患儿阻塞侧骨性鼻泪管较健侧明显扩大,其发生具体原因尚需要进一步研究。     

Origins of lacrimal surgery,and evolution of dacryocystorhinostomy to the present

The creation of an alternative pathway from the lacrimal sac into the nose has been practised for over two millennia. Early historical figures who pioneered lacrimal surgery were Celsus and Galen, treating dacryocystitis by plunging a red‐hot cautery iron through the lacrimal bone into the nose. Better understanding of lacrimal physiology and anatomy led to the introduction of more sophisticated techniques in the 18th century. However, despite these approaches, the technique of Celsus continued to be practised well into the eighteenth and nineteenth centuries. Modern lacrimal surgery began when the Italian otolaryngologist, Toti, described his external dacryocystorhinostomy procedure in 1904. Dupuy‐Dutemps and Bourget refined Toti's procedure, and introduced the technique of anastomosing lacrimal and nasal mucosal flaps which remains the foundation of the external dacryocystorhinostomy performed today. The endonasal dacryocystorhinostomy was described before the external approach, but its popularity and success grew only in recent times.     

先天性鼻泪道阻塞治疗时机及方式选择

先天性鼻泪道阻塞(congenital nasolacrimal duct obstruction,CNLDO)是患儿最常见的眼部疾病之一,其主要特征是鼻泪道下端瓣膜闭塞。CNLDO现有治疗方法包括泪囊按摩、泪道探通术、硅胶管置入术、球囊扩张术、鼻腔泪囊吻合术。近来,联合使用泪道内窥镜,可提高手术成功率。由于疾病本身有自愈倾向,手术时机及治疗方案选择目前存在很多争议,本文就这一问题进行综述, 以便为CNLDO治疗提供参考方案。     

鼻泪管引流管及硅胶管联合置管治疗泪道系统多点阻塞

目的:探讨泪点或泪小管狭窄合并鼻泪管阻塞或合并慢性泪囊炎的泪道引流管治疗方法。方法:临床诊断为泪点或泪小管狭窄合并鼻泪管阻塞或合并慢性泪囊炎的患者23例28眼,经泪道探通后,采用泪道引流管[1]和硅胶管联合置入治疗。结果:术后4mo拔管,随诊1a,患者23例28眼中,23眼无溢泪,泪道冲洗通畅,为治愈,治愈率82%。2眼少许溢泪,泪道冲洗时另一泪点少许返流,探针可达骨壁,可以入咽,为好转,好转率为7%。2眼泪道冲洗原路返流,针头不能达骨壁为无效;1眼泪道冲洗时探针可达鼻骨,但再次出现脓性分泌物,为无效,无效率为11%。结论:鼻泪管引流管和硅胶管联合置入是治疗泪道系统多点阻塞有效的治疗方法。     

Treatment of Acute Purulent Dacryocystitis by Early Bicanalicular Silicone Intubation: Safety,Efficacy, and Outcomes

Purpose: To evaluate the safety, efficacy, and outcomes of early bicanalicular silicone intubation in the treatment of acute purulent dacryocystitis. Methods: This prospective interventional case series focused on acute purulent dacryocystitis from February 2010 to March 2014. Of the 21 cases, 16 cases were treated at the Fujian Provincial Hospital, and five cases were treated at the Lianjiang Hospital. Bicanalicular silicone intubation was inserted in the original lacrimal duct within 10 days after abscess decompression by pus aspiration method and systemic antibiotic application. Data collection included demographic profiles, perioperative and postoperative complications, and revision surgery. Resolution of signs and symptoms of acute purulent dacryocystitis, as well as successful anatomical patency assessed by irrigation, was evaluated. Follow-up times were more than 12 months, and ranged from 14 to 63 months.

Results: All patients showed remarkable improvement of pain and swelling within 48 hours. Resolution of the erythema and edema was observed within one week after bicanalicular silicone intubation combined with topical antibiotic lavage. No intraoperative and postoperative complications were observed. After initial bicanalicular silicone intubation, anatomical success was observed in 66.7% (14/21) of the patients. Of the remaining seven patients who presented with severe reflux in irrigation, two patients chose re-intubation and five patients underwent standard external dacryocystorhinostomy. All patients had anatomical success at last follow-up. Conclusion: Early bicanalicular silicone intubation appears to be a safe, effective, and simple procedure, which offers a reasonable option in the treatment of acute purulent dacryocystitis, especially for those developing and underdeveloped areas.     

泪道探通术治疗鼻泪管阻塞的成功率与年龄之间的相关性

目的:探讨探通术的成功率与鼻泪管阻塞(nasolacrimal duct obstruction,NLDO)患者年龄之间的相关性。方法:患者120例行探通术,并分为3个年龄组:第1组(<12mo),第2组(13～24mo),3组(25～60mo)。所有患者先行保守治疗,阻塞未消除,然后行探通术作为替代治疗,并比较三组间的探通术治愈率。结果:组1,2,3的成功率分别为94.3%,83.3%,68.4%。三组间的治愈率有显著的差异(P=0.017)。结论:早期行探通术可取的较高的成功率。根据我们的观察,NLDO患者早期干预,最好在出生后2a以内,效果肯定。     

鼻泪道阻塞性疾病的治疗现状与进展

泪道疾病是多发病、常见病,特别是鼻泪道阻塞性疾病,传统治疗多采用泪囊鼻腔吻合术和经泪小点泪道探通术。传统的泪囊鼻腔吻合术治疗鼻泪道阻塞性疾病效果可靠稳定;随着鼻内窥镜的发展,产生了一种完美而创伤小的泪囊鼻腔吻合术。近年来新型泪道器材的出现,泪道支架、激光或高频电在临床上广泛应用;泪道探通联合新型泪道支架及其他辅助治疗疗效肯定。现在国内外少数医院开展了具有创伤更小,不改变原有组织结构的微创术（泪道内窥镜技术）,应用于鼻泪道阻塞性疾病诊治;这种显微技术在鼻泪道阻塞性疾病方面的诊治具有良好的发展前景。     

A comparison between monocanalicular and pushed monocanalicular silicone intubation in the treatment of congenital nasolacrimal duct obstruction

AIM: To compare the success rate of monocanalicular versus pushed monocanalicular silicone intubation (PMCI) of the nasolacrimal duct for congenital nasolacrimal duct obstruction (CNLDO).METHODS: In a prospective randomized clinical trial 53 eyes of 49 patients with CNLDO underwent either monocanalicular silicone intubation (MCI) (n=28 eyes) or PMCI (n=25 eyes). All procedures were performed by 1 oculoplastic surgeon. Treatment success was defined as the complete resolution of epiphora at 3mo after tube removal.Results: The surgical outcome was assessed in 20 eyes with MCI and 20 eyes with PMCI. The mean age of treatment was 26.25±10.08mo (range, 13-49mo) for MCI and 26.85±12.25mo (range, 16-68mo) for PMCI. Treatment success was achieved in 18 of 20 eyes (90.0%) in the MCI group compared with 10 of 20 eyes (50%) in the PMCI group (P=0.01). In the PMCI group, the tube loss (30%) was greater than the MCI group (5%), however the differences between the 2 groups proved to be not significant (P=0.91).CONCLUSION: Our results indicate that MCI has higher success rate in CNLDO treatment compared with PMCI in this small series of patients.     

鼻腔逆行植入导管与鼻腔泪囊吻合术对比研究

目的评价鼻腔逆行植入硬膜外麻醉导管手术与鼻腔泪囊吻合术临床效果,探讨鼻腔逆行植入导管手术的应用价值。方法对照观察鼻腔逆行植入硬膜外麻醉导管术与鼻腔泪囊吻合术的疗效、手术操作时间及术中术后并发症。结果两组疗效经卡方检验差异无统计学意义（P=0．897）,鼻腔逆行植管手术操作时间显著短于鼻腔泪囊吻合术（P〈0．05）,且术中术后并发症少。结论鼻腔逆行植入硬膜外麻醉导管手术与鼻腔泪囊吻合术临床效果相近,但操作简便、手术创伤小。     

Surgical outcome and unusual complications of paediatric external dacryocystorhinostomy

Purpose: To report the surgical outcome of external dacryocystorhinostomy (DCR) in children treated for congenital nasolacrimal duct obstruction (CNLDO) at a single tertiary eye hospital.

Materials and Methods: The medical records of 44 consecutive paediatric patients who underwent external DCR with silicon tube intubation from January 2002 to December 2015 were retrospectively reviewed. Age at the time of surgery ranged from 2 to 12 years. Surgical success was defined as resolution of symptoms, normal tear film height, and negative fluorescein dye disappearance test. This study adheres to the principles outlined in the Declaration of Helsinki.

Results: Four patients had simultaneous bilateral surgery (9.1%). Four patients had redo surgery following previous unsuccessful DCR. The patients’ follow-up ranged between 2 and 10 years. There were no cases of serious immediate post-operative complications, but four children developed subcutaneous emphysema, and in two children operated before the age of 2.5 years agenesis of the ipsilateral upper canine was observed. Of the 42 patients who completed follow-up (46 eyes), 39 (43 eyes, 93.5%) had a successful result with complete cure of symptoms.

Conclusions: Paediatric external DCR can successfully treat CNLDO with a low rate of complications. As the bud of the upper canine may be very close to the site of the rhinostomy when this is performed before the age of 3, it cannot be excluded that the agenesis of the ipsilateral upper canine, an unusual finding in Caucasian populations, might be related to the size and the site of the rhinostomy.     

Mode of delivery, birth weight and the incidence of congenital nasolacrimal duct obstruction

AIM: To study any possible association of congenital nasolacrimal duct obstruction (CNLDO) with mode of delivery, birth weight and gestational age. METHODS: We retrospectively reviewed charts of all patients (n=2591) under the age of 3y who were born between April 2015 and May 2017 and were examined at the Ophthalmology Clinic of Emsey Hospital Istanbul, Turkey. We identified patients (n=105) who were diagnosed as CNLDO. The mode of delivery, birth weight and gestational age along with any adverse event during or after delivery or any other health history were determined. Birth statistical data were obtained from the hospital’s medical records database. RESULTS: Gestational age of babies who were born via cesarean section (CS) was lower than gestational age of babies who were born via normal spontaneous vaginal delivery (NSVD; P=0.002). Babies who were born via CS were found to have 3.75 times higher risk of developing NLDO when compared to babies who were born via NSVD (OR=3.754). CONCLUSION: There is a possible association between CS and CNLDO.     

内窥镜下改良球形头硅胶管插管与泪囊鼻腔吻合术治疗鼻泪管阻塞的比较

目的:比较内窥镜下球形头硅胶管插管(SHSI)与泪囊鼻腔吻合术(En-DCR)治疗鼻泪管阻塞(NLDO)的疗效与经济效益。方法:将43例50眼NLDO患者随机分为SHSI组(21例25眼)和En-DCR组(22例25眼),比较两组患者术中出血量、单眼手术时间、手术不适及住院时间,随访至术后12mo,根据末次随访时溢泪与泪道灌洗情况评估临床疗效,并采用成本-效果比(C/E)进行经济效益评估。结果:SHSI组患者术中出血量与手术不适视觉模拟评分显著低于En-DCR组(4.96±1.989mL vs 27.60±14.950mL,2.84±0.64分vs 4.88±0.84分),单眼手术时间与住院时间显著短于En-DCR组(13.40±6.007min vs 59.64±12.786min,0.50±0.010h vs 137.280±23.085h)(均P<0.001)。末次随访时,两组患者临床有效率无差异(88%vs 96%,P>0.05),但SHSI组患者C/E(13.57)远小于En-DCR(121.50)。结论:内窥镜下SHSI与En-DCR均为NLDO的有效手术治疗方法,但SHSI手术难度相对更低且具有明显的成本效益优势。     

先天性鼻泪管阻塞的临床特点及泪道探通术效果的影响因素

目的：探讨先天性鼻泪管阻塞的临床特点及影响泪道探通术效果的因素。方法：本研究通过回顾性分析2010-06/2011-05在我院眼科就诊并行泪道探通术的先天性鼻泪管阻塞的患儿616例687眼,研究内容包括：初次就诊年龄、泪道探通术时年龄、性别、分娩方式、有无脓性分泌物、既往泪道冲洗和泪道探通术病史。总结其临床特点并通过分析以上各因素与泪道探通术成功率的关系,研究先天性鼻泪管阻塞治疗效果的影响因素。泪道探通术成功的标准为：流泪和眼部分泌物等症状消失,泪道冲洗通畅。结果：剖宫产和自然分娩患儿在泪道探通术成功率方面没有统计学差异（P=0.376）,男女之间也没有统计学差异（P=0.498）。泪道探通术成功率与泪道探通术年龄呈负相关关系（r=-0.328,P=0.001）。3～,6～,9～,12～15,＞15月龄手术成功率分别为：100%,97.8%,90.8%,833%和76.5%。有脓性分泌物的患儿手术成功率明显下降（P=0.013）。患儿既往泪道冲洗病史对泪道探通术成功率影响不大（P=0.561）。但有外院泪道探通术病史的患儿,其手术成功率显著下降（P=0.042）。结论：先天性鼻泪管阻塞的泪道探通术成功率随着年龄的增长而下降,而且脓性分泌物也是泪道探通术失败的危险因素。因此对于先天性鼻泪管阻塞的患儿,有效局部控制炎症和早期行泪道探通术是提高泪道探通术成功率的关键。