Surgical punctal occlusion with a high heat-energy releasing cautery device for severe dry eye with recurrent punctal plug extrusion.

PURPOSE: To report the rate of recanalization and the efficacy of punctal occlusion surgery with a high heat-energy-releasing cautery device in patients with severe dry eye disease and recurrent punctal plug extrusion. DESIGN: Prospective, interventional case series. METHODS: Seventy puncta from 44 eyes of 28 dry eye patients underwent punctal occlusion with thermal cautery. All patients had a history of recurrent punctal plug extrusion. A high heat-energy-releasing thermal cautery device (Optemp II V; Alcon Japan) was used for punctal occlusion surgery. Symptom scores, best-corrected visual acuity, fluorescein staining score, rose bengal staining score, tear film break-up time, and Schirmer test values were compared before and 3 months after the surgery. Rate of punctal recanalization also was examined. RESULTS: Three months after surgical cauterization, symptom score decreased from 3.9 ± 0.23 to 0.56 ± 0.84 (P < .0001). Logarithm of the minimal angle of resolution best-corrected visual acuity improved from 0.11 ± 0.30 to 0.013 ± 0.22 (P = .003). Fluorescein staining score, rose bengal staining score, tear film break-up time, and the Schirmer test value also improved significantly after the surgery. Only 1 of 70 puncta recanalized after thermal cauterization (1.4%). CONCLUSIONS: Punctal occlusion with the high heat-energy-releasing cautery device not only was associated with a low recanalization rate, but also with improvements in ocular surface wetness and better visual acuity.

Easy access to esters with a benzylic quaternary carbon center from diallyl malonates by palladium-catalyzed decarboxylative allylation.

Diallyl 2-alkyl-2-arylmalonates underwent palladium-catalyzed decarboxylative allylation quickly under mild conditions. In contrast, no reaction took place with diallyl 2,2-dialkylmalonates under the same conditions. Electron-donating phosphine ligands were found to be vital for this reaction. Most of the solvents used did not affect the catalytic cycle. Catalysis in [bmim][BF4], a well-known ionic liquid, was inhibited as a result of formation of a hydrogen bond between a carboxylate anion and a [bmim]+ cation; however, the reaction in [bdmim][BF4], in which the acidic proton of [bmim][BF4] was replaced with a methyl group, proceeded smoothly. The catalytic mechanism was investigated using a tetradeuterated substrate and an enzymatically synthesized enantio-enriched allyl methyl 2-methyl-2-phenylmalonate. Even the electron-deficient phosphite ligand was found to be active for catalysis of diallyl 2-methyl-2-(2- or 4-nitrophenyl)malonates.