Self-Retaining Bicanaliculus Stents as an Adjunct to 3-Snip Punctoplasty in Management of Upper Lacrimal Duct Stenosis

Chalvatzis, Nikolaos; Tzamalis, Argyrios; Mavrikakis, Ioannis; Tsinopoulos, Ioannis; Dimitrakos, Stavros

doi:10.1097/iop.0b013e31827f5a10

Cited by 34 publications

(19 citation statements)

References 24 publications

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“…This has led to suggestions of adjunctive approaches such as application of mitomycin C 6,7 and punctal plug insertion. 8 Some authors propose adding on self-retaining bicanalicular stents, 9 or mini-monoka tubes 10 on top of snip punctoplasty procedures as associated canalicular stenosis and internal punctal stenosis is quoted to be more than 45% in some series. 3 However, these more complex procedures are also not routinely used in uncomplicated cases.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of punch punctoplasty with Kelly punch and review of literature

Wong

Yuen

2016

Eye

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PurposeTo report long-term outcomes of punch punctoplasty utilizing the Kelly punch and to compare the results with other described methods of punctoplasty in literature.Patients and methodsA retrospective, non-comparative interventional case series of patients who underwent punch punctoplasty at the Hong Kong Eye Hospital over an 8-year period. A standard Kelly Descemet's membrane punch was utilized for punctal enlargement in all cases. Patient records and their operative records were reviewed. Anatomical success was defined by well-patent puncta on follow-up. Functional success was considered complete if tearing resolved completely postop and partial if residual tearing remained despite patent puncta and nasolacrimal drainage system. An OVID MEDLINE review was performed to compare success rates of various punctoplasty surgeries in literature.ResultsIn all, 101 punch punctoplasties from 50 patients were performed between January 2008 to January 2016. At a mean follow-up of 34 months (range: 6-86 months), the anatomical success rate was 94% (95 out of 101 puncta), whereas functional success was 92% (54 out of 59 eyes). Two cases experienced postop dry eyes; otherwise no major complication was observed.ConclusionPunch punctoplasty via the readily available Kelly punch is a simple, minimally invasive procedure that demonstrates high anatomical and functional success as a sole primary treatment for simple punctal stenosis.

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Section: Introductionmentioning

confidence: 99%

Long-term outcomes of punch punctoplasty with Kelly punch and review of literature

Wong

Yuen

2016

Eye

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“…14 The triangular 3-snip is a more traditional way with one cut in the vertical canaliculus, one in the horizontal canaliculus and one cut at the base. 6,10 In contrast, the rectangular 3-snip procedure has two vertical cuts on either side of the vertical canaliculus with one cut at the base and is believed to be better than the triangular 11,15 The current study examines the role of rectangular 3-snip punctoplasty in achieving successful outcomes in a large cohort of acquired punctal stenosis.…”

Section: Introductionmentioning

confidence: 99%

“…Several modalities described in the literature include punctal dilatation, 1-snip punctoplasty, 2-snip punctoplasty, triangular 3-snip punctoplasty, rectangular 3-snip punctoplasty, 4-snip punctoplasty, punctal punching with Kelly's or Riess punch, punctoplasty with mitomycin-C, and inserting perforated punctal plugs, self-retaining bicanalicular stents, or mini-monoka. [5][6][7][8][9][10][11][12][13] Three-snip procedures in its modern form was described by Thomas in 1951. 14 The triangular 3-snip is a more traditional way with one cut in the vertical canaliculus, one in the horizontal canaliculus and one cut at the base.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of rectangular 3-snip punctoplasty in acquired punctal stenosis: is there a need to be minimally invasive?

Ali

Ayyar

Naik

2015

Eye

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Aim To report the clinical profiles of acquired punctal stenosis and outcomes with rectangular 3-snip punctoplasty. Methods Retrospective chart review of all patients who underwent rectangular 3-snip punctoplasty, over a 3-year period from a single surgeon's (MJA) database was performed. Data retrieved include demographics, symptomatology, prior interventions, grades of punctal stenosis, associated ocular findings, and outcomes. A minimum follow-up of 6 months following punctoplasty was considered for analysis. Success was defined as clearance of dye on functional dye disappearance test and resolution of symptoms. Results One hundred and forty five puncta of 87 eyes of 56 patients were studied. The mean age at presentations was 52 years. Puncta (71.7%; 104/145) were of grade 2 size. Epiphora was the commonest presenting symptom noted in 94.3% (82/87) of the eyes. At a minimum follow-up of 6 months, complete resolution of symptoms was achieved in 74.7% (65/87) of eyes. Eight out of 87 eyes (9.1%) failed to show any improvement secondary to lacrimal obstructions distal to the puncta. Five out of 87 (5.7%) eyes showed punctal restenosis whereas 10.3% (9/87) of the eyes had functional epiphora post punctoplasty. Conclusion Puncta of grade 2 size were the most common in this series. Although rectangular 3-snip punctoplasty is an effective and safe procedure for majority of grades 1 and 2 of acquired punctal stenosis, a higher percentages of functional epiphora and punctal restenosis in the remaining patients should propel further investigations into developing nonincisional, minimally invasive alternatives.

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“…20 • It negates the need for a snip procedure and thus reduces the risk of restenosis, scarring, and premature stent loss. 24 • Other advantages-inert, well tolerated, quick, relatively painless, non invasive procedure (Figure 6a Spontaneous loss has been reported in 14.7% after 3 months, 27.3% after 1 year, and 36.8% after 2 years. 23…”

Section: Figure 4: One Snip Punctoplastymentioning

confidence: 99%

“…punctal fibrosis and restenosis. 23A few of the less commonly used procedures for AEPS include-Punch ampullectomy which was introduced by Hughes and Maris in 1967 24. and later modified by Edelstein and Reiss, who introduced the Reiss punctal punch.…”

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confidence: 99%

Recent Advances in Management of Acquired External Punctal Stenosis

Dudeja¹

2015

DJO

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Acquired external punctal stenosis (AEPS) denotes anatomical narrowing of lacrimal punctum, which clinically manifests as epiphora. AEPS may be asymptomatic in a patient with dry eye. Under conditions of normal or excessive tear production; AEPS can produce symptomatic epiphora, which is an indication for intervention. Chronic blepharitis and idiopathic stenosis are the most common etiological factors. Preventable punctal stenosis in patients on long term taxanes or 5-fluorouracil occurs due to systemic absorption of these drugs and secretion in tears. In such cases, AEPS may be prevented by prophylactic lacrimal intubation. AEPS may have associated canalicular stenosis in 45% of cases. This review deals with the etiology, clinical diagnosis and management of AEPS, which has evolved over the years from the earliest description of simple punctal dilatation to present day use of monocanalicular and bicanalicular silicone stents.

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Self-Retaining Bicanaliculus Stents as an Adjunct to 3-Snip Punctoplasty in Management of Upper Lacrimal Duct Stenosis

Abstract: The use of self-retaining bicanaliculus stents seems to improve anatomical, functional, and subjective scores when combined with standard 3-snip punctoplasty in patients with acquired upper lacrimal duct stenosis.

Cited by 34 publications

References 24 publications

Long-term outcomes of punch punctoplasty with Kelly punch and review of literature

Long-term outcomes of punch punctoplasty with Kelly punch and review of literature

Outcomes of rectangular 3-snip punctoplasty in acquired punctal stenosis: is there a need to be minimally invasive?

Recent Advances in Management of Acquired External Punctal Stenosis

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