Antibiotic utilization in endoscopic dacryocystorhinostomy: a multi-institutional study and review of the literature

PURPOSE

Utilization of antibiotics for endoscopic dacryocystorhinostomy (endo-DCR) is largely dependent on individual surgeon preference. This study aimed to investigate prescribing practices of pre-, peri-, and postoperative antibiotics and effects on postoperative infection rates in patients who underwent endo-DCR.

METHODS

A retrospective chart review of institutional data at two academic centers of endo-DCR cases from 2015-2020 was performed. Postoperative infection rates for patients who received pre-, peri-, and postoperative antibiotics, individually or in combination, and those who did not, were compared via odds ratio and ANOVA linear regression.

RESULTS

331 endo-DCR cases were included; 22 cases (6.6%) had a postoperative infection. There was no significant difference in the infection rates between patients without an active preoperative dacryocystitis who received different permutations of peri- and postoperative antibiotics. Patients who received preoperative antibiotics within two weeks of surgery for preexisting acute dacryocystitis, but did not receive peri- or postoperative antibiotics, had a higher rate of postoperative infections (p = 008).

CONCLUSIONS

Our data suggest antibiotics may be beneficial only when patients have a recent or active dacryocystitis prior to surgery. Otherwise, our data do not support the routine use of antibiotic prophylaxis in endo-DCR.

Diverse Research Teams and Underrepresented Groups in Clinical Studies

Importance

Several ophthalmic diseases disproportionately affect racial and ethnic minority patients, yet most clinical trials struggle to enroll cohorts that are demographically representative of disease burden; some barriers to recruitment include time and transportation, language and cultural differences, and fear and mistrust of research due to historical abuses. Incorporating diversity within the research team has been proposed as a method to increase trust and improve engagement among potential study participants.

Objective

To examine how demographic factors of potential research participants and personnel may be associated with patient consent rates to participate in prospective ophthalmic clinical studies.

Design, Setting, and Participants

This retrospective cohort study included patients from an urban, academic hospital who were approached for consent to participate in prospective ophthalmic clinical studies conducted between January 2015 and December 2021.

Main Outcomes and Measures

Multivariable logistic regression assessing associations between patient and research personnel demographics and rates of affirmative consent to participate was used.

Results

In total, 1380 patients (mean [SD] age, 58.6 [14.9] years; 50.3% male) who were approached for consent to participate in 10 prospective ophthalmic clinical studies were included. Of prospective patients, 566 (43.5%) were Black; 327 (25.1%), Hispanic or Latino; 373 (28.6%), White; 36 (2.8%), other race and ethnicity; and 78 (5.8%) declined to answer. Black patients (odds ratio [OR], 0.32; 95% CI, 0.24-0.44; P < .001) and Hispanic or Latino patients (OR, 0.31; 95% CI, 0.20-0.47; P < .001) were less likely to consent compared with White patients. Patients with lower socioeconomic status were less likely to consent than patients with higher socioeconomic status (OR, 0.43; 95% CI, 0.33-0.53; P < .001). Concordance between patient and research staff race and ethnicity was associated with increased odds of affirmative consent (OR, 2.72; 95% CI, 1.99-3.73; P < .001).

Conclusions and Relevance

In this cohort study, patients from underrepresented racial and ethnic groups and those with lower socioeconomic status were less likely to participate in ophthalmic clinical studies. Concordance of race and ethnicity between patients and research staff was associated with improved participant enrollment. These findings underscore the importance of increasing diversity in clinical research teams to improve racial and ethnic representation in clinical studies.

Unilateral Familial Exudative Vitreoretinopathy: Clinical Profile and Pathology

We report a case of a newborn with unilateral retinal detachment that could not be repaired. At examination under anesthesia, the retina was markedly abnormal and a presumptive diagnosis of retinal dysplasia was made. Several years later, the eye was enucleated because it was blind and painful. Final pathology was consistent with familial exudative vitreoretinopathy (FEVR). The literature describing unilateral retinal dysplasia is sparse. This case adds to the clinical spectrum of pathologic findings in FEVR.

Non-Arteritic Anterior Ischemic Optic Neuropathy in Pilots

BACKGROUND: Non-arteritic anterior ischemic optic neuropathy (NAION) is a common cause of optic neuropathy with the exact pathophysiology unknown. Risk factors include advanced age, small optic nerve head, hypertension, diabetes mellitus, and sleep apnea.⁶ High altitude is considered another risk factor, although only few cases have been reported. No cases of NAION have been reported to occur during flight.CASE REPORT: A 41-yr-old male pilot presented with vision change while performing high G-force maneuvers in an A10 fighter jet. He developed a paracentral visual field defect superiorly in the left eye. Contrasted MRI was within normal limits. The left optic nerve showed blurred margins while the right was sharp, but cupless. The left eye had similar episodes 16 mo before and 8 mo after, but not during flight.DISCUSSION: Our case may be the first reported NAION during flight in an airplane pilot. Our patient was an active U.S. Air Force pilot whose second episode of NAION occurred while performing maneuvers in a fighter jet. The patient is younger than expected for NAION and he did not have any of the commonly associated risk factors. His nonflight episodes suggest he was predisposed to NAION. G-force maneuvers, which restrict blood flow and force blood to the extremities away from the optic nerve head, were the precipitant of his second NAION. With a single case, whether high G maneuvers in general are a risk factor for NAION is unknown.Distefano AG, Lam BL. Non-arteritic anterior ischemic optic neuropathy in pilots. Aerosp Med Hum Perform. 2018; 89(11):1005-1007.