Surgical management of lacrimal punctal cauterization in chronic GVHD-related dry eye with recurrent punctal plug extrusion

Abstract

We investigated the efficacy of lacrimal punctal occlusion surgery with a cautery device in patients with chronic GVHD (cGVHD) -related dry eye, with recanalization of puncta and recurrent punctal plug extrusion. A total of 23 puncta from 14 eyes of 10 patients with chronic GVHD (cGVHD)-related dry eye underwent punctual thermal cauterization with a high-temperature disposable cautery device. All patients were refractory to conventional treatment, including artificial tear eye drops, autologous serum eye drops and vitamin A eye drops, and had a history of recanalization and recurrent punctal plug extrusion. The effect of lacrimal punctal cauterization by thermal cautery device was evaluated by changes in subjective symptom scores, corrected distance visual acuity, Schirmer's test values, fluorescein staining scores, rose bengal staining scores, and tear-film break-up time before and 3 months after the surgery. Subjective symptom scores, Schirmer's test values, fluorescein and rose bengal scores, and tear-film break-up time improved significantly 3 months after the surgery. Recanalization of puncta was not observed in all the cases (0 of 14 eyes, 0%). Lacrimal punctal cauterization was effective with no recanalization and significant improvements in subjective symptoms and the ocular surface environment in cGVHD-related dry eye patients who had been refractory to conventional treatments.

Tissue Renin–Angiotensin System in Lacrimal Gland Fibrosis in a Murine Model of Chronic Graft-Versus-Host Disease

“…Current strategies for the treatment of dry eye associated with cGVHD include increasing lubrication with artificial tears, topical ointment, controlling evaporation with eyelid management, draining control with punctal occlusion, and decreasing ocular surface inflammation by immunosuppressants. 17 In addition to these treatments, other special treatments, such as autologous serum eye drops, 18 methylcellulose eye drops, 19 topical tranilast, 20 medical-use contact lenses, 21 amniotic membrane transplantation, 22 and surgical management of lacrimal punctal cauterization 23 have been reported to alleviate dry eye symptoms and to lead to objective improvement.…”

Ophthalmic Procedures for Treatment of Advanced Ocular Surface Diseases

“…27,28 Choosing an appropriately sized plug for the patient can improve outcomes, but in patients who are dependent on permanent punctal occlusion, high-temperature cautery is often an acceptable option. 29,30 After local subcutaneous anesthesia is given, hightemperature disposable cautery devices or Hyfrecator electrocautery probes (CONMED, Utica, NY) can be inserted into the lacrimal punctum where heat or electric current is applied, resulting in shrinkage and whitening of tissue around the cautery tip. 29 The cautery tip is then carefully removed, and the resultant tissue destruction and scarring permanently close the lacrimal punctum.…”

“…29,30 After local subcutaneous anesthesia is given, hightemperature disposable cautery devices or Hyfrecator electrocautery probes (CONMED, Utica, NY) can be inserted into the lacrimal punctum where heat or electric current is applied, resulting in shrinkage and whitening of tissue around the cautery tip. 29 The cautery tip is then carefully removed, and the resultant tissue destruction and scarring permanently close the lacrimal punctum. Dry eye symptoms, best-corrected visual acuity, fluorescein and rose bengal staining, tear break-up time, and Schirmer test values are typically significantly improved, and recanalization rates are exceedingly low.…”

Human Albumin Eye Drops as a Therapeutic Option for the Mmanagement of Keratoconjunctivitis Sicca Secondary to Chronic Graft-Versus-Host Disease after Stem-Cell Allografting

“…When necessary, some patients were managed with concurrent temporary or permanent punctal occlusion to increase tear retention time, improving moisture to the outer eye 13,14 . Human albumin in the form of an eye drop was offered to patients who were refractory to all previous medical and surgical interventions.…”