Microbiological spectrum of microbial keratitis in patients presenting with nasolacrimal duct obstruction
Supriya Sharma, Srikant K Sahu, Suryasnata Rath, Aparajita Mallick, Savitri Sharma, Sujata Das
Read MoreSubjective outcome and quality of life following external dacryocystorhinostomy
Dani, Koshal; Yadalla, Dayakar; Joy, Anupama; Wu, Annie M; R, Jayagayathri
Read MorePurpose:
To assess the patient reported outcome and quality of life in post external dacryocystorhinostomy operated patients.
Methods:
A prospective questionnaire based study was carried out on 112 patients diagnosed with chronic dacryocystitis who underwent external dacryocystorhinostomy in the department of Orbit and Oculoplasty at a tertiary eye hospital in South India.
Results:
We included 112 cases in our study. Mean (SD) of the age of patients was 48.03 (12.79) years and ranged from 7 to 72 years of age. 44 (39.3%) patients were males and 68 (60.7%) were females. All cases had subjective symptoms of tearing, pain and swelling at baseline which were relieved by post-operative 3 in all cases. The mean (SD) best corrected visual acuity was 0.28 (0.39) at baseline and 0.25 (0.37) at postoperative 3 (p < 0.001). All four parameters studied in the GBI questionnaire – total mean GBI (32.22 vs 48.86, P < 0.001), general subscale (31.21 vs 44.08, P < 0.001), social health (46.28 vs 61.01, P < 0.001), physical outcome (22.17 vs 55.80, P = 0.0001) scores showed significant improvement from 1 vs 3 months post DCR.
Conclusion:
The GBI questionnaire is an effective tool for assessing patients’ quality of life following DCR. External DCR can not only produce a successful anatomical outcome but also bring about a measurable improvement in subjective symptoms and quality of life among patients with symptomatic NLDO.
COMMENTARY:
Ali, Mohammad Javed
Lacrimal drainage disorders have complex physical, functional, and psychosocial impacts on the patient’s quality of life. Hence, the evaluation of posttreatment outcomes should extend far beyond the routine anatomical and functional success. Several quality-of-life questionnaires or scoring systems with numerous parameters have been used and validated for lacrimal disorders. They include Glasgow Benefit Inventory (GBI), the nasolacrimal duct obstruction symptom score (NLDO-SS), lacrimal symptom questionnaire (Lac-Q), ocular surface diseased index (OSDI), and the visual function questionnaire (VFQ-25).[1]
Journal : IJO
Assessment of conjunctival flora in eyes with lacrimal passage obstruction before and after successful dacryoendoscopic recanalisation
Takahiro Hiraoka, Sujin Hoshi, Kuniharu Tasaki, Tetsuro Oshika
Read MoreBackground To investigate conjunctival bacterial flora in eyes with lacrimal passage obstruction before and after dacryoendoscopic recanalisation with lacrimal tube intubation.
Methods One-hundred fifty eyes with lacrimal passage obstruction that were successfully treated by dacryoendoscopic recanalisation were enrolled. Conjunctival sampling was done for each eye before and 4 months after surgery. The lower fornix was rubbed by a sterile cotton swab, and the collected samples were cultured with several agar plates. Colonies were differentiated and enumerated by standard bacteriological laboratory techniques.
Results Positive bacterial growth was detected in 42.0% of all the samples before surgery, and the positivity rate significantly decreased to 26.0% after surgery (p=0.0051). The number of strains detected also decreased from 20 before surgery to 9 after surgery, especially pathogenic microorganisms decreased. In addition, drug-resistant bacteria such as penicillin-resistant Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus were detected in nine eyes before surgery but were detected only in one eye after surgery. Coagulase-negative Staphylococci and Corynebacterium spp., which are common in normal conjunctival flora, accounted for 46.5% of all the isolates before surgery and 80.9% after surgery, showing a significant increase in the rate after surgery (p<0.0001).
Conclusions This study showed that physiological recanalisation of lacrimal passage after dacryoendoscopic surgery significantly decreased the culture positivity rate of conjunctival sac and the number of microorganism strains detected. It also decreased the number of potentially pathogenic and drug-resistant bacteria and increased the percentages of indigenous bacteria, causing the normalisation of conjunctival flora.
Journal : BJO
Office- or Facility-Based Probing for Congenital Nasolacrimal Duct Obstruction
David G. Morrison, Gil Binenbaum, Melinda Y. Chang, Gena Hejdary, MD, PhD, Rupal H. Trivedi, Jennifer A. Galvin, Stacy L. Pineles
Read MorePurpose
To review the published literature assessing the efficacy and safety of in-office probing compared with facility-based probing to treat congenital nasolacrimal duct obstruction (NLDO).
Methods
Literature searches were conducted in March 2020 in the PubMed database with no date restrictions and limited to studies published in English and in the Cochrane Library database with no restrictions. The combined searches yielded 281 citations. Of these, 21 articles were deemed appropriate for inclusion in this assessment and assigned a level of evidence rating by the panel methodologist. Four articles were rated level I, 2 articles were rated level II, and 15 articles were rated level III.
Results
Treatments consisted of observation, in-office nasolacrimal probing, or facility-based nasolacrimal probing. Success rates and complications or recurrences were recorded from 1 week to 6 months after surgery. Complete resolution of symptoms after surgery ranged from 66% to 95.6% for office-based procedures versus 50% to 97.7% for facility-based procedures. Level I evidence indicated that 66% of cases spontaneously resolved after 6 months of observation in infants between 6 and 10 months of age. Success rates for in-office probing were lower for bilateral than for unilateral NLDO (67% vs. 82%), whereas success rates were high in both unilateral (83%) and bilateral (82%) patients who underwent facility-based probing after 6 months of observation. Cost data did not indicate a definitive cost savings of either treatment method ($562 for in-office vs. $701 for facility-based, depending on cost models predicting spontaneous resolution rates at different ages). No serious adverse events with treatment or anesthesia were reported for either treatment method.
Conclusions
Evidence supports the efficacy and safety of both in-office and facility-based surgery for congenital NLDO. However, treating bilateral NLDO in a facility setting may be better. Because a significant percentage of children achieved resolution spontaneously before 12 months of age, deferring treatment until 12 to 18 months of age is a reasonable option. Additional research may address symptom burden on families and the impact of anesthesia and emotional trauma of nonsedated office probings on patients and may explore further the cost of treatment for each treatment method.
https://www.aaojournal.org/article/S0161-6420(20)31030-7/fulltext
Journal : Ophthalmology
Automatic screening of tear meniscus from lacrimal duct obstructions using anterior segment optical coherence tomography images by deep learning
Hitoshi Imamura, Hitoshi Tabuchi, Daisuke Nagasato, Hiroki Masumoto, Hiroaki Baba, Hiroki Furukawa & Sachiko Maruoka
Read MorePurpose
We assessed the ability of deep learning (DL) models to distinguish between tear meniscus of lacrimal duct obstruction (LDO) patients and normal subjects using anterior segment optical coherence tomography (ASOCT) images.
Methods
The study included 117 ASOCT images (19 men and 98 women; mean age, 66.6 ± 13.6 years) from 101 LDO patients and 113 ASOCT images (29 men and 84 women; mean age, 38.3 ± 19.9 years) from 71 normal subjects. We trained to construct 9 single and 502 ensemble DL models with 9 different network structures, and calculated the area under the curve (AUC), sensitivity, and specificity to compare the distinguishing abilities of these single and ensemble DL models.
Results
For the highest single DL model (DenseNet169), the AUC, sensitivity, and specificity for distinguishing LDO were 0.778, 64.6%, and 72.1%, respectively. For the highest ensemble DL model (VGG16, ResNet50, DenseNet121, DenseNet169, InceptionResNetV2, InceptionV3, and Xception), the AUC, sensitivity, and specificity for distinguishing LDO were 0.824, 84.8%, and 58.8%, respectively. The heat maps indicated that these DL models placed their focus on the tear meniscus region of the ASOCT images.
Conclusion
The combination of DL and ASOCT images could distinguish between tear meniscus of LDO patients and normal subjects with a high level of accuracy. These results suggest that DL might be useful for automatic screening of patients for LDO.
https://link.springer.com/article/10.1007/s00417-021-05078-3
Journal : Graefe's Archives
Prognostic factors for local recurrence and survival and impact of local treatments on survival in lacrimal gland carcinoma
Joshua Richard Ford, Maria Laura Rubin, Steven Jay Frank, Jing Ning, James Matthew Debnam, Diana Bell, Adel El-Naggar, Renata Ferrarotto, Bita Esmaeli
Read MoreBackground/aims To identify prognostic factors for local recurrence, distant metastasis and disease-specific survival (DSS) for lacrimal gland carcinoma.
Methods All consecutive patients with lacrimal gland carcinoma treated from January 1998 through December 2018 were included. Log-rank tests and univariate Cox proportional hazards regression models were used to study risk factors and survival.
Results Overall, 55 patients were included in this study, and 5 patients were excluded from the survival analysis. Median age was 46 years (range: 10–76). 43 patients (78%) had adenoid cystic carcinoma (ACC). 31 patients (56%) had T2 disease at presentation. 28 patients (51%) underwent orbital exenteration with or without adjuvant radiotherapy or chemoradiation, 26 (47%) underwent eye-sparing surgery with or without adjuvant radiotherapy or chemoradiation, and 1 received palliative chemoradiation. 11 patients (22%) experienced local recurrence; 14 (29%) experienced distant metastasis. Five- and 10-year local-recurrence-free survival rates were 0.71 (95% CI 0.58 to 0.88), and 5- and 10-year distant-metastasis-free survival rates were 0.67 (95% CI 0.53 to 0.85) and 0.49 (95% CI 0.30 to 0.81), respectively. There was no significant difference in risks of local recurrence, distant metastasis or DSS between ACC patients who had orbital exenteration and those who had eye-sparing surgery. Perineural invasion was negatively associated with local-recurrence-free survival (p=0.02). Among patients with ACC, basaloid/solid histologic type was associated with significantly worse DSS than non-basaloid/solid histologic type (p<0.01).
Conclusions For lacrimal gland carcinoma, orbital exenteration with adjuvant therapy and eye-sparing surgery with adjuvant therapy are associated with similar recurrence outcomes. Eye-sparing surgery is associated with better DSS. Perineural invasion is a risk factor for local recurrence. ACC with basaloid/solid subtype correlates with worse DSS.
Journal : BJO
Management of proximal lacrimal obstructions: a rationale
Francesco M. Quaranta-Leoni, Maria Grazia Fiorino, Fabio Serricchio, Flavia Quaranta-Leoni
Read MorePurpose
To identify a rationale for correct surgical treatment of proximal lacrimal obstructions.
Methods
Retrospective review of 775 consecutive patients (974 eyes) with proximal lacrimal obstructions, operated on with customized surgery by a senior surgeon (FMQL) from January 2003 to December 2018.
Results
In case of punctal stenosis, punctoplasty was as effective as punctal dilatation with monocanalicular or bicanalicular stent (p > 0.05). In proximal canalicular obstructions, failure rate of dacrocystorhinostomy with retrograde intubation (R-DCR) was significantly higher in case of false inferior passage creation than in case of no false passage creation (p = 0.02). In mid-canalicular obstructions failure rate of R-DCR was 41.3%, and bypass surgery with Jones tube at second stage was likely. Trephination and monocanalicular intubation, performed in selected cases, had a failure rate respectively of 16.6% and 21.7% in mid and distal canalicular obstructions. Canaliculodacryocystorhinostomy (CDCR) was successful in 77% of cases of proximal common canalicular obstruction. Bypass surgery is the treatment of choice in case of no residual patency, and rates of tube extrusion were significantly reduced with the use of StopLoss Jones tubes (SLJT) (1.7%) with respect to standard tubes (12%), (p = 0.04, Fisher’s exact test).
Conclusion
Patient history and accurate diagnosis of the site of obstruction are essential for a correct surgical choice. Less invasive techniques as trephination and intubation may be effective, but should be reserved to patients with no associated lower lacrimal obstruction. Further studies require specific randomized clinical trials, and a standardized protocol adopted by different clinical centres.
Journal : Acta Ophthalmologica
Ref : Canalicular block DCR Lacrimals Punctal stenosis Punctoplasty
Microbial spectrum and antibiotic sensitivity in infantile dacryocystitis
Huiling Qing, Zhengwei Yang, Menghai Shi, Junge Zhang, Shengtao Sun & Lei Han
Read MorePurpose
To identify the characteristics and the spectrum of microbial agents of infantile dacryocystitis and to assess the trends in both antibiotic sensitivities and pathogens over the past 10 years.
Methods
The microbial and medical records of 546 culture-proven patients (546 eyes) of infantile dacryocystitis diagnosed at Henan Eye Hospital between January 2009 and December 2018 were retrospectively reviewed. Patient demographics, microbial analysis, and susceptibility rates to various antibiotics were done. A chi-squared test for trends was applied to evaluate changes in antibiotic susceptibility and microbial spectrum over time.
Results
A total of 546 patients with infantile dacryocystitis were documented. The average age was 2.97 ± 4.15 months, and 42.7% were female. The proportion of gram-positive microbes, gram-negative microbes, and fungi was 80.2, 19.4, and 0.4%, respectively. Minocycline was sensitive to gram-positive bacteria (98.0%). Imipenem was sensitive to gram-negative bacteria (89.2%). Increasing susceptibility was observed in two bacterial isolates: Staphylococcus aureus (P = 0.005) and Streptococcus mitis (P = 0.001). Decreasing susceptibility was observed in one bacterial isolate: Staphylococcus epidermidis (P < 0.0001). Increasing microbial susceptibility over time was detected for 12 antibiotics. Decreasing microbial sensitivity was observed for one antibiotic.
Conclusions
The most common cause of infantile dacryocystitis is Staphylococcus epidermidis. Though a significant trend towards increasing microbial sensitivity to some antibiotics was observed, including glycopeptides, cephalosporins, fluoroquinolones, tetracyclines, and lincosamides, a significant trend towards decreasing microbial sensitivity to amikacin was also detected.
https://link.springer.com/article/10.1007/s00417-020-05026-7
Journal : Graefe's Archives
Introducing the concept of “Lacriome”
Mohammad Javed Ali
Read MoreThe lacrimal sciences have seen several stupendous advances in the past few decades in diagnostics and therapeutic interventions. However, the same cannot be claimed for the disease etiopathogenesis. Understanding the lacrimal disease mechanisms and their molecular pathogenesis is the next logical step to advance the science. In this context, the concept of “Lacriome” is being introduced by the author as an umbrella term that defines the collective microenvironments of the lacrimal system. The lacrimal microenvironment is a small yet distinct biophysical environment integral to the structure and functions. This includes a variety of cellular and molecular profiles, secreted factors, extracellular proteins, metabolic by-products, and exogenous agents. Several interactions in the lacrimal microenvironments can contribute to the disease pathogenesis. For example, soluble glycoproteins, hormonal microenvironments, and tear microenvironments are suspects in the etiopathogenesis of primary acquired nasolacrimal duct obstruction [1,2,3].
The broad constituents of a “Lacriome” include the lacrimal microbiome, metagenome, lacrimal metabolome, lacrimal glycome and lipidome, lacrimal epigenome and genome, lacrimal proteome, and transcriptome. The constituents by no means are exhaustive, and several more can be added as our understanding progresses. All these “omes” can be studied with specific techniques called “omics,” for example, metagenomics, proteomics, lipidomics, genomics, glycomics, and transcriptomics, or a variable combination of them called “multi-omics.” The methodologies of several “omics” have significantly evolved and can be applied to the lacrimal system. It is important to have an umbrella term “Lacriome” to integrate the various molecular processes of the lacrimal system and to study their interactions with each other within the specific lacrimal ecosystem. This would enable studies of each lacrimal disease from a holistic perspective and a better understanding of the pathophysiology as a whole.
Broad constituents of the Lacriome
Lacrimal microbiome refers to the microbial communities within the lacrimal habitat with potentially distinct functions. The physical and functional features of these specific microbial communities are further characterized by the study of their metagenomics and meta-transcriptomics.
Lacrimal metabolome refers to the study of primary and secondary metabolites of the lacrimal ecosystem and involves qualitative and quantitative measurement of the metabolic response of the lacrimal system to physiological and pathological stimuli.
Lacrimal proteome refers to the lacrimal ecosystem’s protein profile and involves the study of exogenous or endogenous cellular proteins and their molecular pathways.
Lacrimal transcriptome refers to the specific coding and non-coding RNA transcripts involved with the function of lacrimal microenvironments and measures gene expression of the lacrimal tissues.
Lacrimal lipidome refers to the lipid profile of the lacrimal ecosystem and involves the study of pathways and networks of cellular lipids and their multiple interactions with other microenvironments.
Lacrimal glycome refers to the sugar (simple and complex) profile of the lacrimal ecosystem and involves a systematic assessment of all the glycan structures of the lacrimal tissues.
The integrative concept and approach of “Lacriome” will further propel focused studies of lacrimal microenvironments. This, in turn, will enhance the understanding of lacrimal disorders and translate to better patient management. While decoding the “Lacriome” in its entirety is a significant challenge, the audacious goals of today will usher in a bright future. As Nobel Laureate George Bernard Shaw once said, “The future belongs to the unreasonable ones, the ones who look forward not backward, who are certain only of uncertainty, and who have the ability and the confidence to think completely differently.”
https://link.springer.com/article/10.1007/s00417-020-05049-0
Journal : Graefe's Archives
Canalicular laceration repair using a self-retaining, bicanalicular, hydrophilic nasolacrimal stent
Clara J. Men, Audrey C. Ko, Lilangi S. Ediriwickrema, Catherine Y. Liu, Don O. Kikkawa & Bobby S. Korna
Read MorePurpose: To evaluate outcomes of primary eyelid and canalicular laceration repair using a self-retaining bicanalicular hydrophilic nasolacrimal stent.
Methods: This study is a retrospective review of seven patients with canalicular laceration primarily repaired with a self-retaining bicanalicular nasolacrimal stent within 72 hours of initial injury. After lacrimal intubation, repair was performed by reapproximation of the lacerated tissues. Data collection included ophthalmic examination, mechanism of injury, involvement of upper/lower/common canaliculi, symptoms of epiphora, operative time, stent extrusion and canalicular irrigation.
Results: Seven patients with monocanalicular laceration were repaired using the self-retaining bicanalicular nasolacrimal stent. The stent was left in place an average of 5 months. The average operative time was 29.3 minutes. None of the stents extruded prior to removal. After 5 months, the stent was removed successfully without difficulty. All patients reported subjective improvement in epiphora, with complete resolution of symptoms. Anatomic success was confirmed with irrigation in all cases. There were no complications associated with usage of the self-retaining bicanalicular nasolacrimal stent.
Conclusions: Primary repair of canalicular lacerations can be successfully performed with a self-retaining bicanalicular nasolacrimal stent. This stent has several advantages, including potentially faster operative times, no need for intranasal fixation or retrieval, easier intubation in the lacrimal system, and improved anatomic reapproximation of lacerated tissues.
https://www.tandfonline.com/doi/full/10.1080/01676830.2020.1768559
Journal : Orbit
Ref : Canalicular laceration Eyelid laceration Lacrimals Nasolacrimal stenting