Journal List > J Korean Ophthalmol Soc > v.57(2) > 1010486

Ahn, Eom, Rhim, Kang, Kim, and Song: The Effects of Surgical Punctual Occlusion on Patients with Aqueous Deficient Dry Eye

Abstract

Purpose

To analyze the improvement of symptoms and signs of dry eye after surgical punctual occlusion and to evaluate the effects of secondary systemic disease in dry eye patients.

Methods

From March 2011 to July 2014, 15 eyes of 8 dry eye patients with a history of punctal plug insertion underwent surgical punctal occlusion. Schirmer test was measured based on mean 2.9 mm. The patients consisted of 4 dry eye patients with Sjogren's disease, 1 with rheumatoid arthritis, 1 with graft-versus-host disease (GVHD), and 2 with no secondary systemic disease. Preoperative and postoperative ophthalmic examinations of log MAR visual acuity, subjective symptoms, corneal staining (National Eye Institute [NEI] score), and tear break-up time (BUT) were performed and the effects of secondary systemic disease in dry eye patients were evaluated. The results of surgical punctual occlusion were analyzed.

Results

All patients showed a statistically significant improvement of log MAR visual acuity, subjective symptoms, corneal staining (NEI score), and tear BUT. The patients with rheumatoid-related diseases showed improved symptoms after surgery, but the patient with GVHD showed no significant improvement after surgery. Among the study patients, 80.0% showed completely closed punctum and 20.0% showed partial recanalization.

Conclusions

Surgical punctal occlusion is an effective alternative in patients with severe aqueous deficient dry eye who show recurrent punctal plug loss or complications associated with punctal plugs.

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Figure 1.
Anterior segment photography of dry eye patient with rhematologic disease. (A) Pre-treatment (A-1: right/A-2: left). (B) After punctal plug insertion (B-1: right/B-2: left). (C) One month after surgical punctal occlusion (C-1: right/C-2: left).
jkos-57-195f1.tif
Table 1.
Demographic and clinical data of subjects enrolled in this study
Study group
No. of patients 8
Age (years) 53.4 ± 8.7
Gender (male/female) 1/7
OU/OD/OS 7/0/1
Secondary systemic disease (yes/no) 6/2
  Sjogren's disease 4
  Secondary Sjogren's disease 1
  GVHD 1
Factor (positive/negative)
  Ro 4/4
  La 3/5
  RF 3/5

Values are presented as mean ± SD unless otherwise indicated. OU = oculus unitas; OD = oculus dexter; OS = oculus sinister; GVHD = graft versus host disease; RF = rhematoid factor.

Table 2.
Comparison of pre and post-operative change
Visual acuity (log MAR) Symptom* Corneal staining BUT (sec)
Pre 0.30 ± 0.37 3.67 ± 0.49 9.07 ± 3.01 1.47 ± 0.52
Post 0.14 ± 0.24 2.13 ± 1.06 4.67 ± 3.29 3.00 ± 1.69
p-value 0.002 0.001 0.001 0.001

Values are presented as mean ± SD unless otherwise indicated.

log MAR = logarithm of the minimum angle of resolution; BUT = tear break-up time.

* 0 no, 1 mild, 2 moderate, 3 moderate to severe, 4 severe; National Eye Institute (NEI) score; Wilcoxon signed rank test was used. p-value less than 0.05 was considered statistically significant.

Table 3.
The result of surgical punctal occlusion (last F/U)
Total occlusion Partial recanalization Total recanalization
N 12 3 0
Percentage (%) 80.0 20.0 0

F/U = follow up.

Table 4.
Complications of punctal plug insertion
Success Plug loss Granuloma Ocular pain
N 2 10 1 2
Percentage (%) 13.3 66.7 6.7 13.3
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