title: Novel Therapy for Primary Canaliculitis: A Pilot Study of Intracanalicular Ophthalmic Corticosteroid/Antibiotic Combination Ointment Infiltration.
abstract: In patients with primary canaliculitis, conservative medical therapy is associated with a high recurrence rate. Surgical treatments carry a great resolution rate but sometimes can result in the lacrimal pump dysfunction and canalicular scarring. The aim of this study is to introduce a minimally invasive approach, intracanalicular ophthalmic corticosteroid/antibiotic combination ointment infiltration (IOI, intracanalicular ointment infiltration), and to report our preliminary results for treating primary canaliculitis. In this retrospective, interventional case series, 68 consecutive patients with newly developed primary canaliculitis at a major tertiary eye center between January 2012 and January 2015. Thirty-six patients received conservative medical treatment alone (group 1; 36 eyes). Twenty-two patients and 10 medically uncontrolled patients from group 1 underwent IOI therapy (group 2; 32 eyes). Ten patients and 26 recurrent patients from group 1 and group 2 underwent surgery (group 3; 36 eyes). Patients were followed-up for at least 8 weeks. Clinical characteristics and outcomes were analyzed and compared. In this study, patients' age, sex, onset location, and durations of disease among 3 groups showed no significant difference. The resolution rate in group 2 was 72.7% (16/22) for new patients and 68.8% (22/32) for gross patients, respectively, both of which are higher than that of group 1 (22.2%, 10/36) but lower than that of group 3 (100%, 36/36). Of group 3, 2 patients received 2 surgical interventions and resolved finally. Microbiological workup was available in 51 patients. The most common isolates were staphylococcus species (27.9%) and streptococcus species (20%). Canalicular laceration developed in 1 patient during the IOI procedure and 1 patient undergoing surgery. Only 2 had postoperative lacrimal pump dysfunction and 1 had canalicular scarring in group 3. The IOI may be an effective and minimally invasive technique for treating primary canaliculitis and obviate the need for further intensive surgery.
authors.affiliation: From the Department of Ophthalmology and Visual Science, Eye, and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai (JX, XS, YL, YL, DW, YY, AW, YZ, CL, JH); School of Life Sciences, Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian, China (ZL, JH); Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA (AM, JH); and China State Key Laboratory of Medical Neurobiology, Institutes of Brain Science (XS); Key Laboratory of Myopia, National Health and Family Planning Commission, Shanghai, China (XS).
authors.forename: Jianjiang
authors.initials: J
authors.lastname: Xu
authors.forename: Zuguo
authors.initials: Z
authors.lastname: Liu
authors.forename: Alireza
authors.initials: A
authors.lastname: Mashaghi
authors.forename: Xinghuai
authors.initials: X
authors.lastname: Sun
authors.forename: Yi
authors.initials: Y
authors.lastname: Lu
authors.forename: Yimin
authors.initials: Y
authors.lastname: Li
authors.forename: Dan
authors.initials: D
authors.lastname: Wu
authors.forename: Yujing
authors.initials: Y
authors.lastname: Yang
authors.forename: Anji
authors.initials: A
authors.lastname: Wei
authors.forename: Yujin
authors.initials: Y
authors.lastname: Zhao
authors.forename: Chun
authors.initials: C
authors.lastname: Lu
authors.forename: Jiaxu
authors.initials: J
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000069282:Canaliculitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D003907:Dexamethasone / Q000008:administration & dosage*; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D056965:Injections, Intraocular; D008297:Male; D008875:Middle Aged; D009824:Ointments; D010865:Pilot Projects; D012189:Retrospective Studies; D014031:Tobramycin / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; D009824:Ointments; D003907:Dexamethasone; D014031:Tobramycin