Outcomes of Anterior-Side Rectangular 4-Snip Punctoplasty for Patients with Punctal Stenosis

Eun Joo Kim; Dong Su Shin; Hong Jae Mun; Kyoo Won Lee; Byung Jin Jeong

doi:10.3341/jkos.2013.54.12.1803

Journal List > J Korean Ophthalmol Soc > v.54(12) > 1009551

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Kim, Shin, Mun, Lee, and Jeong: Outcomes of Anterior-Side Rectangular 4-Snip Punctoplasty for Patients with Punctal Stenosis

Original Article

J Korean Ophthalmol Soc 2013;54(12):1803-1809.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.12.1803

Outcomes of Anterior-Side Rectangular 4-Snip Punctoplasty for Patients with Punctal Stenosis

Eun Joo Kim, MD¹, Dong Su Shin, MD², Hong Jae Mun, MD¹, Kyoo Won Lee, MD¹, Byung Jin Jeong, MD¹

¹Cheil Eye Hospital, Daegu, Korea

²Shin’s Eye Clinic, Daegu, Korea

Address reprint requests to Byung Jin Jeong, MD Cheil Eye Hospital, #1 Ayang-ro, Dong-gu, Daegu 701-820, Korea, Tel: 82-53-959-1751, Fax: 82-53-959-1758, E-mail: zoroman@hanmail.net

Received 31 May 20133 August 2013 Accepted 10 November 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the efficacy of anterior-side rectangular 4-snip punctoplasty, a modification of posterior ampullec-tomy that is currently used in patients with punctal stenosis.

Methods

We performed a retrospective chart review of patients with punctal stenosis who underwent anterior-side rectangular 4-snip punctoplasty at our hospital. Fluorescein dye disappearance test (FDT) and questionnaire on tearing symptoms and tear meniscus height (TMH) based on spectral-domain optical coherence tomography (SD-OCT) were evaluated in preoperative and postoperative follow-up examinations of the patients. Anatomical success was defined as punctum without re-stenosis at last visit; functional success was defined as FDT grade of 0 or 1, or tearing symptom score of 2 or less.

Results

A total of 44 anterior-side 4-snip punctoplasty procedures were performed in 27 patients. The average age of all subjects was 56.0 ± 11.0 years (range, 39 to 82 years). The mean follow-up period was 9.4 months (range, 6 to 20 months). FDT, tearing symptom score (p < 0.01, Wilcoxon signed-rank test), and TMH (p < 0.01, paired t-test) were significantly decreased after surgery. Anatomical success was 40/44 cases (90.9%) and functional success was 38/44 cases (86.4%). There were no complications such as skin defect or cosmetic problems.

Conclusions

Anterior-side rectangular 4-snip punctoplasty is an effective surgical procedure for patients with punctal stenosis, maintaining functions of the lacrimal drainage system without re-stenosis of punctum.

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Keywords: Anterior-side, Punctal stenosis, SD-OCT, 4-snip punctoplasty

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Figure 1.

Surgical procedures of the anterior-side 4-snip punctoplasty. (A) The punctum is dilated with a punctal dilator. (B) The first, horizontal cut is made with a pair of Vanna’s scissors. (C, D) Two vertical cuts are made from the edge of the first horizontal cut. (E) Finally, the base of the flap is removed. (F) The dilated punctum is shown.

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Figure 2.

Tear meniscus height by spectral-domain optical coherence tomography. (A) Three vertical scans passing cornea, tear meniscus and lower eyelid were performed at 6 o’clock position. (B) The tear meniscus height was measured with a caliper.

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Figure 3.

Dye disappearance test, tearing symptom score and tear meniscus height were decreased significantly after surgery. (A) Dye disappearance test, (B) Tearing symptom score, (C) Tear meniscus height, ^* Wilcoxon signed-rank test; ^† paired t-test.

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Figure 4.

(A) Preoperative stenotic punctum is shown. (B) Postoperative 6 months, dilated punctum was maintained.

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Table 1.

Questionnaire of tearing symptoms

	Never	Rarely	Sometimes	Frequently	Always
1. Do you frequently shed tears or have watery eyes?	□	□	□	□	□
2. Do you frequently dry your tears with a handkerchief or tissue because tears stream down your cheeks?	□	□	□	□	□
3. Is there a disturbance in your daily life because of tearing symptom?	□	□	□	□	□
4. Do you feel pain or discomfort owing to tears in your eyes?	□	□	□	□	□
5. Is your tearing symptom aggravated when you are outside?	□	□	□	□	□

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