dacryocystitis journal reading treatment and prognosis

journal

1. First-Onset Dacryocystitis : Characterization, Treatment, and Prognosis Pembimbing : dr. Freili Akay Sp.M Journal Reading

2. Introduction Dacryocystitis is a common disease at the ophthalmic emergency room Etiology  nasolacrimal duct, secondary infection, inflammatory, trauma, dacryolith, or neoplasm The most frequently isolated bacterial organisms are Staphylococcus species

3. Introduction Other common pathogens are gram negative bacteria such as Escherichia coli, Haemophilus influenzae, or Pseudomonas species The infection is treated with systemic and/or local antibiotics Surgical drainage is often indicated when an abscess is present Lacrimal surgery is required if the nasolacrimal obstruction results in chronic epiphora or recurrent dacryocystitis

4. Introduction The most basic procedure is nasolacrimal duct probing and a stent can be inserted Dacryocystorhinostomy (DCR) is performed in patients with epiphora and previous dacryocystitis , or if probing and intubation of the lacrimal drainage system fails

5. Method Design and Subject retrospective retrospective study Patients with PCME who received 2 mg IVT or 40 mg STT Patients who had first-onset dacryocystitis Criteria Inclusion The inclusion criteria were met by 52 patients who had first-onset dacryocystitis treated Inclusion criteria Patients were required to have a minimum of 3 months of follow-up after IVT or STT Jjhj jhkh exclusion criteria Exclusion Patients with dacryocystitis during this period, with the first-onset infection earlier, Cases where the clinical description was not consistent with acute dacryocystitis . Patients who died during 3-years follow-up period were also excluded. Patients receiving any other periocular, intravitreal, or systemic corticosteroid other than IVT or STT within 3 months prior to first IVT or STT injection or during the 6-month follow-up period Patients with a complicated cataract surgery or radiation retinopathy, proliferative diabetic retinopathy (PDR), dia - betic macular edema (DME), and/or vitreomacular traction (VMT) Place and Time Skane University HospitalSweden during the years 2010–2013 Wills Eye Hospital, Philadelphia, USA 2 mg IVT from March 2012 to March 2017 or 40 mg STT from January 2015 to March 2017

6. Procedure Patients were identified by searching the hospital’s medical records using ICD10 diagnosis code H043 (acute and unspecified inflammation of lacrimal passages). The following factors were analyzed : –  Recurrent dacryocystitis –  Age (mean, median, and range) –  Gender (female-to-male ratio) –  Choice of antibiotic treatment: including dose and duration –  Recurrent infections, defined as a new episode of dacryocystitis a minimum of 1 month after completed treatment of a previous episode –  Lacrimal surgery: type of operation, need for reoperation –  Cultures: number of cases in which cultures were taken, and bacteria isolated –  Surgical drainage: number of cases of abscess justifying incision

7. Result A total of 52 patients with first-onset dacryocystitis during 2010–2013 met the inclusion criteria and were included in the study It was a mix of patients with different etiologies , such as congenital nasolacrimal duct obstruction (CNLDO) and primary acquired nasolacrimal duct obstruction (PANDO) The mean age of these patients was 51.6 years The female-to-male ratio was 3:1 (73.1%)

8. Result The mean duration of antibiotic treatment during infection was 13.7 days T he most common treatment was flucloxacillin capsules combined with chloramphenicol eye drops or ointment

9. Result Incision of the lacrimal sac due to the presence of an abscess was performed in 8 patients (15.4%). Cultures of purulent discharge were taken in 15 patients (29%) All these patients were antibiotic-free when cultures were taken Staphylococcus aureus was the most frequently isolated bacterium (8/15 cases). One culture showed the growth of H. influenzae, while the remaining six cultures showed no bacterial growth.

10. Result 15 patients (29%) suffered one or more recurrences of dacryocystitis . Most new infections occurred during the first year of follow-up, where the number of episodes averaged 0.29 During the follow-up period, 18 patients (34.6%) underwent lacrimal surgery because of chronic epiphora and/or recurrent infections. 9 patients underwent DCR, 7 probing and intubation, and 2 dacryocystectomy (Table 3 ).

11. Result C omparison the group of patients treated with antibiotics and that who also underwent surgical procedures . The group had a higher average age, duration of treatment, and number of recurrences in the first year of follow-up Further analysis of the group that had undergone surgical procedures showed differences in age and recurrences of infection

12. Discussion F irst-onset dacryocystitis was more common in middle-aged and elderly people F emale dominance F irst-onset dacryocystitis no surgery being required, some patients had recurrent infections and lacrimal surgery was required Our review of patient records showed that the treatment of first-onset dacryocystitis differed The length of antibiotic treatment seemed to be correlated to the severity of lacrimal obstruction

13. Discussion Incision of the lacrimal abscess was performed in only a few of all cases of dacryocystitis (15.4%) Only one of the 18 patients undergoing surgery had recurrent dacryocystitis during the follow-up period and had to be operated on again both external and endoscopic DCR are very effective treatments for lacrimal stenosis None of the patients treated with probing and stent intuba - tion had recurrent dacryocystitis during the first year of follow-up

14. Conclusion To summarize, of the 52 patients with first-onset dacryocystitis , only 29% had another episode of dacryocystitis within 3 years. DCR had an excellent success rate in reducing the risk of recurrent dacryocystitis . The majority of patients with first-onset dacryocystitis had no further episodes of dacryocystitis . Some patients experience recurrent and complicated infections

15. Journal Apraisal

16. Journal Apraisal Are the results of this research valid? (screening question) Does the research address a clearly focused problem? Study population Intervention Comparison Yes ( √ ) Don’t know ( ) No ( ) 52 patients who had first-onset dacryocystitis , given a ntibiotics and Surgery Treatment then observed bt follow-up for 3 years

17. Was the selection of study patients random? Yes () Don’t know ( ) No ( √ ) Patients are not taken randomly

18. Are all trial patients properly accounted for in its conclusion? Is the follow up complete? Are patients analyzed in randomized groups? Yes (√ ) Don’t know ( ) No ( ) Follow-up was complete for up to 3 years and observed for recurrence of dacryocystitis episodes

19. Were patients , health care providers , and study personnel “ blinded ” to treatment ? Yes ( ) Don’t know ( ) No (√ ) The medical team knows what therapy will be given and what the patient's condition is.

20. Were the groups similar at the start of the trial? Yes (√ ) Don’t know ( ) No ( ) All patients were the same at the start of the study, patients with first-onset dacryocystitis

21. Aside from the experimental intervention, were the groups treated equally? Yes (√ ) Don’t know ( ) No ( ) Groups are treated equally. In this study, all patients were given antibiotic therapy and surgery

22. What is the result? How good is the treatment effect? What outcomes are measured? Yes (√ ) Don’t know ( ) No ( ) The treatment effect is good. Of the 52 patients with first-onset dacryocystitis , only 29% had another episode of dacryocystitis within 3 years.

23. Are the results applicable? Can the results be applied to local populations? Do you think the patients covered by the trial are similar enough to your population? Yes(√ ) Don’t know ( ) No ( ) This can be applied because patients can meet the inclusion and exclusion criteria.

24. Are all clinically important outcomes considered? If not, does this influence the decision? Yes (√ ) No ( ) All clinical outcomes were considered, including complications related to the interventions performed.

25. Are the benefits worth the cost? Yes (√ ) No ( ) The benefits are worth the downsides and costs. Every intervention comes with risks and benefits and in this study the benefits outweighed the risks.

26. Applicability Can be applied

27. Thank You