Clinical characteristics and treatment outcomes of chronic dacryocystitis-related corneal ulcers
10.3760/cma.j.cn115989-20220113-00013
- VernacularTitle:慢性泪囊炎相关角膜溃疡的临床特征及治疗转归
- Author:
Qing HUANG
1
;
Fengmei SHAN
;
Jie LI
;
Xiaoyu ZHANG
;
Xiuhai LU
;
Fuhua WANG
;
Hua GAO
;
Xiaolin QI
Author Information
1. 山东第一医科大学附属眼科医院（山东省眼科医院） 山东第一医科大学（山东省医学科学院） 山东省眼科研究所 山东省眼科学重点实验室 省部共建国家重点实验室培育基地，济南 250021
- Keywords:
Dacryocystitis;
Corneal ulcers;
Bacteria;
Drug sensitivity test;
Treatment outcomes
- From:
Chinese Journal of Experimental Ophthalmology
2024;42(5):442-447
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical characteristics and treatment outcomes of chronic dacryocystitis-related corneal ulcers and to provide a basis for the rational clinical diagnosis and treatment.Methods:An observational case series study was performed.A total of 31 patients (31 eyes) diagnosed with chronic dacryocystitis-related corneal ulcers in Eye Hospital of Shandong First Medical University were enrolled from January 2016 to January 2020, with an average age of (53.0±10.8) years.The typical ocular signs, results of the etiological examination and microbial sensitivity test, treatment process and outcomes were analyzed.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Eye Hospital of Shandong First Medical University (No.20191020-1).Written informed consent was obtained from each subject before any medical examination.Results:The average history of chronic dacryocystitis was (3.6±1.9) years.Corneal ulcers were mostly located in the peripheral cornea and had a rounded morphology with clear borders.The positive rate of corneal scraping was 74.2%(23/31), with bacteria in 19 eyes, fungal hyphae in 3 eyes, and both gram-positive cocci and fungal hyphae in 1 eye.The positive rate of microbial culture was 74.2%(23/31), with positive bacterial culture in 20 eyes (gram-positive cocci in 16 eyes and gram-negative bacilli in 4 eyes) and fungal growth in 3 eyes.The sensitivity rates of gram-positive cocci to vancomycin, rifampicin, moxifloxacin, and levofloxacin were 100%(16/16), 87.5%(14/16), 81.3%(13/16), and 75.0%(12/16), respectively.All patients were treated with surgery for chronic dacryocystitis, including 22 cases of endoscopic dacryocystorhinostomy, 7 cases of dacryocystectomy, and 2 cases of lacrimal duct probing combined with intubation.Among the 9 cases with an ulcer depth of <1/3 of the corneal thickness (CT), 6 cases were cured after (10.8±3.2) days of drug treatment and 3 cases underwent corneal lesion resection.The 6 patients with an ulcer depth of 1/3-2/3 of the CT underwent conjunctival flap covering surgery.Among the 16 patients with an ulcer depth of >2/3 of the CT, lamellar keratoplasty was performed in 6 cases, penetrating keratoplasty in 8 cases and evisceration in 2 cases with infectious endophthalmitis.Conclusions:Chronic dacryocystitis-related corneal ulcers are mainly located at the periphery of the cornea, and gram-positive cocci infections are the most common pathogenic bacteria.In patients with mild symptoms, corneal ulcers heal gradually after treatment with sensitive antibiotics.For patients with severe infections, appropriate surgery should be selected according to the depth of the corneal ulcer.
