Preliminary study on the correlation between primary lacrimal punctal stenosis and epiphora by using AS-OCT / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To quantify the lacrimal punctum using anterior segment optical coherence tomography(AS-OCT)and analyze the correlation between the epiphora and primary punctal stenosis.METHODS: A cross-sectional study. There were 43 healthy volunteers(57 eyes)and 44 patients(62 eyes)with primary lacrimal punctal stenosis and epiphora enrolled in the Lacrimal Center of the Third Medical Center of PLA General Hospital from September 2020 to January 2021. The inferior punctum of all subjects were scanned by AS-OCT, and the images were quantified in order to observe the AS-OCT image features. The outer punctal diameter, punctal depth, tear well diameter and tear well depth were all measured simultaneously. The inferior punctum's punctal reserve and punctal reserve ratio were estimated according to the available parameter data.RESULTS: 1)The measured parameters conforming to normal distribution were expressed as mean±standard deviation. The observation group's outer punctal diameter, tear well diameter, tear well depth, and punctal reserve ratio were 458.19±63.58μm, 200.34±84.69μm, 188.95±87.50μm and 0.32±0.18, respectively, while the control group's outer punctal diameter, tear well diameter, tear well depth and punctal reserve ratio were 655.53±82.62μm, 230.26±107.02μm, 275.30±144.34μm, 0.46±0.23, respectively. The parameters in observation group were all lower than those of control group(P<0.05); 2)Parameter data that did not conform to normal distribution were expressed as medians and quartiles, and the results were as follows: the punctal depth in the observation group was 265.50μm(interquartile range 204.25-328.77)μm and the punctal reserve was 71.53μm(interquartile range 46.12-111.37)μm, respectively, while the punctal depth in the control group was 468.76μm(interquartile range 420.50-588.88)μm and the punctal reserve was 182.16μm(interquartile range 131.36-309.84)μm. This difference was statistically significant(P<0.05); 3)In the observation group, there was a negative correlation between the epiphora and the outer punctal diameter(r=-0.448, P<0.05), a positive correlation between the epiphora and tear well depth(r=0.335, P<0.05), and a negative correlation between the epiphora and the punctal reserve and punctal reserve ratio coefficient(r=-0.520, -0.566, P<0.05).CONCLUSION: The AS-OCT can aid in enhancing punctal morphology cognition; The outer punctal diameter and tear well depth are related to the epiphora; The primary punctal stenosis patients with smaller outer punctal diameters are more likely to have the symptom of epiphora, and in patients with punctal stenosis, the greater the potential capacity of the punctum to hold tears, the lesser the degree of epiphora.

Assessing the outcomes of mini-Monoka stent dilatation for primary punctal stenosis using the lacrimal symptom questionnaire

Purpose: The objective of this study was to assess the quality of outcomes of mini-Monoka stent dilatation for punctal stenosis using the lacrimal symptom (Lac-Q) questionnaire. Methods: Prospective interventional case series of 45 eyes of 25 consecutive patients who underwent mini-Monoka stent dilatation for primary punctal stenosis were included in the study. The stents were extubated at 4 weeks. The Lac-Q questionnaire was administered preoperatively and at 12 weeks and 24 weeks following the intervention. Outcomes assessed were anatomical success, functional success, and changes in the questionnaire scores including total, social impact, and lacrimal symptom scores. Statistical analysis was performed using the Wilcoxon signed-rank test, and the probability of obtaining a certain score was calculated using the multinomial log-linear model. P < 0.05 was considered as significant. Results: Monoka stents were performed for 45 eyes. A total of 75 questionnaire responses were analyzed. At the last follow-up of 24 weeks, the anatomical and functional success rates were 93.3% (42/45). The changes in the mean total score (7.68 preoperatively to 0.82 at 24-week follow-up) were statistically significant (P ? 0.001). The mean social impact scores showed significant improvement postoperatively from 4.06 to 0.53 (P ? 0.001). The mean lacrimal symptom score changed from a preoperative value of 3.62 to 0.28 (P ? 0.001) at the last follow-up. Postoperative scoring correlated well with the anatomical and functional success rates. The symptom scores corroborated with changes in the clinical outcomes. Conclusion: Mini-Monoka stent dilatation is a very effective intervention for the management of primary punctal stenosis, and Lac-Q questionnaire is a simple and useful tool to evaluate the quality of outcomes in such cases.

Trabeculectomy punch combined with a novel RS tube for the treatment of punctal stenosis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the feasibility and clinical effect of punctoplasty by using trabeculectomy punch combined with a novel RS tube for the treatment of punctal stenosis.METHODS: Totally 39 patients (39 eyes) with punctual stenosis were selected from October 2013 to October 2015 in the Second People`s Hospital of Foshan.All patients underwent punctoplasty by using trabeculectomy punch combined with a novel RS tube.These tubes were removed at 3mo after operation.A follow-up of 6mo was taken for final analysis.The fluorescein dye disappearance test score was recorded before the operation and at 1,3 and 6mo after the extubation.The curative effect of the operation at 6mo after the extubation was assess.RESULTS: Fluorescein dye disappearance test: the scores at 1,3 and 6mo after the extubation all decreased compared with the preoperative ones.The difference was statistically significant(P<0.05).At the last following up, 35 eyes (90%) were cured completely, 4 eyes (10%) were improved significantly, no patients recurred.Effective rate was 100%.No serious intraoperative and postoperative complications happened.CONCLUSION: Punctoplasty by using trabeculectomy punch combined with novel RS tubes is a safe and effective method for the punctul stenosis, which is easy to perform, with high success rate.

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

PURPOSE: To evaluate the efficacy of anterior-side rectangular 4-snip punctoplasty, a modification of posterior ampullectomy 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.

Punctoplasty Using a Radiofrequency Surgical Unit for Punctal Stenosis

PURPOSE: To introduce and assess the results of punctoplasty using a radiofrequency surgical unit for punctal stenosis. METHODS: Patients who complained of epiphora, had an intact lacrimal pathway below puncti, and underwent punctoplasty with the Ellman Surgitron F.F.P.F were evaluated in the present study. RESULTS: A total of 19 patients (31 eyes) were included in the study. The average age was 55 years (+/-15.7 years). At the last follow-up visit, 27 eyes (87%) had patent puncti, 1 eye became stenotic again, and 3 eyes were completely obstructed. Twenty-two eyes (71%) showed almost complete disappearance of dye on the fluorescein dye-disappearance test (FDDT). Twenty-five eyes (81%) had symptomatic improvement. No significant complication was reported postoperatively. CONCLUSIONS: Punctoplasty with a radiofrequency surgical unit is a simple and effective method for punctal stenosis.

Punctoplasty using Cut Down Tube

PURPOSE: We introduce a new surgical procedure for punctal stenosis, which is to insert a soft and thin cut-down tube, commonly used in general surgery. METHODS: After two snip operation, we inserted cut-down tube into canaliculus through incised punctum. We cut the tube for not touching to the cornea and buried in incision site. At postoperative 1 day, we asked patients their uncomfortness and examined ocular state with slit lamp. And then we removed the tube 4 days later. At postoperative 2 month, we evaluated whether epiphora improved or not and estimated the size of dialted punctum with caliper. Dye disappearance test and lacrimal irrigation test were also performed. RESULTS: Of 11 patients, 8 patients had no epiphora. Average diameter of dilated punctum was 1.77 +/- 0.20mm. In all patients, we found dilated punctum more than 1mm and confirmed patency by lacrimal irrigation test. 8 patients did not feel uncomfortness, and 3 patients felt a little uncomfortness. But no one felt severe discomfort. Although we found corneal erosion and conjunctival injection in 2 patients, they recovered in a few days. CONCLUSIONS: By this procedure, we reduced patient's hospital visit and pain resulting from postoperative care. And we observed well dilated punctum after the procedure. Therefore, punctoplasty using cut down tube is useful procedure for punctal stenosis, especially for recurrent stenosis after snip operation.

Silicone Intubation for Treatment of Punctal Stenosis

PURPOSE: To evaluate the surgical results and complications of silicone intubation in patients with epiphora by punctal stenosis. METHODS: We reviewed the records of 35 eyes of 23 patients who had undergone silicone intubation from 1998 to 2002 and followed more than 1 year postoperatively. RESULTS: Following 1 year postoperatively, 33 eyes (94.3%) showed no epiphora, 2 eyes (5.7%) showed intermittent epiphora. Complications after silicone intubation included prolapse of tube in 3 eyes, punctal slitting in 1 eye, itching in 6 eyes, foreign body sensation in 2 eyes, discharge from punctum in 3 eyes and intranasal discomfort in 1 eye. CONCLUSIONS: Silicone intubation seemed to be an alternative method in patient with epiphora due to punctal stenosis and also a useful method to treat upper and lower punctum.

A Simple Test for Epiphora Caused by Punctal Stenosis

Punctal stenosis may be caused by several etiologies and easily treated by punctoplasty with accompanying procedures. History taking, external and slit-Iamp examinations, and diagnostic tests and imaging techniques of lacrimal system identified lacrimal system abnormalities. Occasionally satisfactory result was not gained after punctoplasty, so author introduce the simple test to aid diagnosis of punctal stenosis and to predict surgical result of punctoplasty. If the fluorescein dye disappearance test documents a dilation, additional fluorescein dye disappearance test was performed to evaluate the efficacy of punctal dilation to relieve the epiphora. This procedure will be helpful in the case of subtle punctal stenosis and evaluation of surgical result.