Three-snip punctoplasty versus perforated plugs for management of lacrimal punctal stenosis

Abstract

Purpose To compare rectangular three-snip punctoplasty and polyvinylpyrrolidone-coated perforated punctal plugs for treatment of acquired lacrimal punctal stenosis. Patients and methods In a prospective comparative non-randomized interventional study, 80 eyes with acquired lacrimal punctal stenosis were classified into two groups. Group A was treated by insertion of polyvinylpyrrolidone-coated perforated punctal plugs (FCI ophthalmics)™ and Group B was treated by rectangular three-snip punctoplasty. The study was done in Minia University Hospital between January 2018 and April 2019. Exclusion criteria included allergic punctal stenosis, lid malposition, and lacrimal obstruction distal to the punctum. All patients were subjected to complete history taking, slit lamp examination of tear meniscus height, fluorescein dye disappearance test, punctal position, shape, size, grading of stenosis, and grading of epiphora. Results The mean age of the patients was 43.85 ± 14.93 years. They were 30 females and 10 males. Eepiphora Grade 3 or 4, improved postoperatively to Grade 0 or 1 in 97.5% of eyes in Group A versus 55% of eyes in Group B. All eyes (100%) in Group A versus 21 eyes (52.5%) in Group B improved regarding fluorescein dye disappearance test grade ( p < 0.001). Restenosis did not occur after plug removal, while it occurred in 10% of eyes subjected to three-snip punctoplasty. Conclusion Perforated punctal plugs and three-snip punctoplasty are safe and effective in treatment of punctal stenosis. However, perforated plugs are less invasive, better tolerated, and have more stable results compared to three-snip punctoplasty.

Prevalence and Determinants of Punctal Occlusion at Ophthalmology Outpatient Clinic at Tanta University Hospital

“…We did a correlation between the previous causes and age; we noted that multiple causes of punctual occlusion related to aging. In addition, the results of Tamer et al [17] revealed that 46 eyes (57.5%) had Grade 1 punctal stenosis, and 34 eyes (42.5%) had Grade 2. Twenty-four eyes (30%) had epiphora Grade 3 and 56 eyes (70%) had epiphora Grade 4.…”

The relationship between histopathological features and surgical success in primary acquired punctal stenosis

“…Amongst the different punctoplasty procedures described in the literature, rectangular TSP has become popular due to its ability to prevent the disruption of the horizontal canaliculus required for the normal lacrimal pump mechanism, with a success rate that varies between 74.7% and 93.8%. 12,19–21 Chak and Irvine 12 reported 93.8% anatomical and 89.8% functional success rates at mean 8.2 months follow-up. However, Ali et al 19 reported that complete resolution of symptoms was achieved in 74.7% of eyes, although 94.3% anatomical success rate a minimum 6 months follow-up.…”

“…However, Ali et al 19 reported that complete resolution of symptoms was achieved in 74.7% of eyes, although 94.3% anatomical success rate a minimum 6 months follow-up. Tamer et al 20 demonstrated 90% surgical success, and Singh et al 21 reported 84% anatomical success rates at 6-month follow-up. In general, the variations in the success rates of rectangular TSP may be related to the difference in the follow-up period as the restenosis rate is more likely to increase over time.…”

Evaluation of implanted perforated lacrimal punctal plugs using anterior segment optical coherence tomography

“…Regarding position, no plug dislodgment or migration was found in this study. In the study of Abd El Ghafar et al [ 13 ] two plugs out of 30 (6.7%) had extruded before 6 months postoperatively versus one plug out of 45 plugs within 2 weeks in the study of Ozgur et al [ 14 ], and also one out of 40 during the 1st month in the study of Tamer et al [ 15 ], who reported additional rotation of four plugs (10%) via the slit lamp examination. The perforated plug was designed to have a shorter medial side compared with the lateral side so that its collar has a higher flange towards the temporal side of the lacrimal papillae and a lower one towards the medial side of the punctum in relation to the lacus lacrimalis to ensure better tear drainage.…”