Department of Ophthalmology, Lions Eye Institute, Albany Medical Center, Ophthalmic Plastic Surgery, Albany, New York 12159, USA.
Ophthalmic Plast Reconstr Surg. 2009 Nov-Dec;25(6):455-7. doi: 10.1097/IOP.0b013e3181b80c59.
To evaluate the frequency of acquired lacrimal sac fistula formation after incision and drainage for dacryocystitis and to determine associated risk factors.
National multicenter retrospective study of acquired lacrimal sac fistula formation in patients receiving incision and drainage during the course of treatment for dacryocystitis between January 2005 and December 2007. Data collection included patient demographics, past medical history, procedure technique, culture results, and details of the medical and surgical management. The formation of a persistent fistula was ascertained, in addition to the subsequent treatment of the dacryocystitis.
Thirty-nine patients from 9 centers were included. Reasons cited for performing incision and drainage included a tense, pointing abscess, severe pain not relieved with narcotics, periorbital cellulitis, dacryocystitis refractory to antibiotics alone, and the need to control infection prior to dacryocystorhinostomy. In 33 of 39 patients (84.6%), incision and drainage and associated medical treatment cured the dacryocystitis. Only 2 of 39 patients (5.1%) developed a persistent fistula following incision and drainage. No risk factors of statistical significance were identified. Dacryocystorhinostomy to correct associated nasolacrimal duct obstruction was subsequently performed in 36 of 39 (92.3%).
Incision and drainage of the lacrimal sac can be an appropriate adjunctive treatment strategy for selected cases of dacryocystitis. Incision and drainage provides appropriate culture media, symptomatic pain relief, and can facilitate resolution. In this series, persistent lacrimal sac fistula formation after incision and drainage and associated medical and surgical treatment for dacryocystitis was rare.
评估切开引流治疗泪囊炎后获得性泪囊瘘形成的频率，并确定相关的危险因素。
对 2005 年 1 月至 2007 年 12 月期间因治疗泪囊炎而行切开引流的患者进行全国多中心回顾性研究，以评估获得性泪囊瘘形成的频率。数据收集包括患者人口统计学资料、既往病史、手术技术、培养结果以及泪囊疾病的医疗和手术管理细节。确定了持续性瘘管的形成，以及随后对泪囊炎的治疗。
9 个中心共纳入 39 例患者。行切开引流的原因包括：紧张的、突出的脓肿、麻醉剂不能缓解的严重疼痛、眶周蜂窝织炎、单纯抗生素治疗无效的泪囊炎、以及需要在泪囊鼻腔吻合术之前控制感染。39 例患者中的 33 例（84.6%）接受切开引流和相关的药物治疗后治愈了泪囊炎。只有 2 例（5.1%）在切开引流后出现持续性瘘管。未发现有统计学意义的危险因素。为纠正相关鼻泪管阻塞，随后对 39 例患者中的 36 例（92.3%）进行了泪囊鼻腔吻合术。
切开引流术可以作为治疗特定类型泪囊炎的一种适当的辅助治疗策略。切开引流术提供了适当的培养介质，可缓解症状性疼痛，并有助于治愈。在本系列中，切开引流和相关的药物和手术治疗泪囊炎后，持续性泪囊瘘形成罕见。
