Goel R, Nagpal S, Kamal S, Kumar S, Mishra B, Loomba P S
Nepal J Ophthalmol. 2016 Jul;8(16):119-127. doi: 10.3126/nepjoph.v8i2.16992.
Intubation in primary transcanalicular laser assisted dacryocystorhinostomy (TCLADCR) is performed to increase the success rates. However, the associated inflammation and infection can have adverse effects.
To study the microbial infection and drug susceptibility of extubated silicone tubes and final anatomical patency in patients undergoing TCLADCR.
A non-randomised prospective interventional study was conducted in a tertiary care eye centre. The study included twenty consecutive adult patients with primary nasolacrimal duct obstruction. They underwent TCLADCR with bicanalicular silicone intubation. The stents were removed at 2 months and subjected to culture sensitivity, followed by administration of appropriate antimicrobial agents. Main outcome measures studied were the microbial spectrum on the cultured tubes, their sensitivity profile and its correlation with final anatomical patency.
A positive culture was obtained in 100% cases, comprising of normal commensals and pathogenic organisms. Of the total 24 isolates, 16 (66.6%) Gram positive bacteria (75% Staphylococcus aureus) and 8 (33.3%) Gram negative bacteria (commonest E.coli) were found, with 4 tubes having more than one isolate. No fungal growth was seen. Ninety percent success rate was achieved at one year following appropriate antimicrobial therapy except in 2 patients with gram negative isolates who had failed to take the prescribed antibiotics following sensitivity reports. There was no correlation between multiple infections and success rate. However, by using the Fisher exact test, a positive correlation was obtained between appropriate antibiotic treatment and the final anatomical patency (p less than 0.05).
Silicone intubation predisposes to microbial growth, which if neglected, can lead to failure of TCLADCR.
在原发性经泪小管激光辅助泪囊鼻腔造口术（TCLADCR）中进行插管是为了提高成功率。然而，相关的炎症和感染可能会产生不良影响。
研究接受TCLADCR的患者拔管后的硅胶管微生物感染及药敏情况，以及最终的解剖通畅情况。
在一家三级眼科护理中心进行了一项非随机前瞻性干预研究。该研究纳入了20例连续的成年原发性鼻泪管阻塞患者。他们接受了双泪小管硅胶插管的TCLADCR。支架在2个月时取出并进行培养药敏试验，随后给予适当的抗菌药物。研究的主要观察指标是培养管上的微生物谱、它们的药敏情况及其与最终解剖通畅的相关性。
100%的病例培养结果呈阳性，包括正常共生菌和病原菌。在总共24株分离菌中，发现16株（66.6%）革兰氏阳性菌（75%为金黄色葡萄球菌）和8株（33.3%）革兰氏阴性菌（最常见的是大肠杆菌），4根管子有不止一种分离菌。未发现真菌生长。除2例革兰氏阴性菌分离株患者在药敏报告后未按规定服用抗生素外，适当的抗菌治疗后一年的成功率达到90%。多重感染与成功率之间无相关性。然而，通过Fisher精确检验，适当的抗生素治疗与最终的解剖通畅之间存在正相关（p小于0.05）。
硅胶插管易导致微生物生长，如果忽视，可能导致TCLADCR失败。
