LAUSR

To the Editor, I am very grateful to Drs. Yazici and Unal for their letter regarding our recent investigation into the role of systemic antibiotics in the setting of lacrimal surgery. Their comments and insights are certainly quite thorough, and I appreciate their enthusiasm for the subject material. The authors are correct that our study did not specify the type of dacryocystorhinostomy. Notably, the patients involved in our study all received external surgeries, perhaps making our results even more compelling, in light of the contention by Drs. Yazici and Unal that external lacrimal surgery could carry higher rates of infection. While the authors express surprise regarding the number of patients that faced previous infection, our study was not powered to explore the reason for these infections. The authors have asked what role previous infection may play in the postoperative infection. Certainly, a preexisting infectious nidus in an area of stasis is likely a source of recurrent infection. Furthermore, oral antibiotics are unlikely to provide a sterile environment within the lacrimal system. Notably, a previous study indicated a greater likelihood of positive microbial growth on cultures from the lacrimal sacs of patients with a history of dacryocystitis. I respectfully disagree with the assertion that our study does not advance our knowledge regarding the role of antibiotics in this setting. The authors are correct that surgical factors may contribute to the risk of postoperative infections. However, as clearly documented in the manuscript, these surgeries were performed by a single surgeon. The technique was thus standardized, suggesting that all patients faced the risks inherent to the technologies mentioned by Drs. Yazici and Unal. Again, this standardization may underscore the impact of the results of this study. Certainly, further investigations may provide prospective data to guide decisionmaking, but our analysis indicates a proof of the general principle. Finally, I salute the authors’ enthusiasm for the investigation in which one of them participated in 2002. Of course, the design of that study and the present investigation are markedly different. Yazici and Meyer utilized antibiotics only in the setting of active inflammation or significant discharge, whereas the treatment strategy employed in the current study did not use antibiotics at all. That study was not included in our manuscript, as it asked a different question and utilized a different protocol.