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Clin Ophthalmol. 2018 Mar 6;12:463-472. doi: 10.2147/OPTH.S155209. eCollection 2018.

A new surgical approach for punctal occlusion using fibrous tissue from under the lacrimal caruncle.

Author information

1
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
2
Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Abstract

Purpose:

Surgical punctal occlusion is indispensable for the treatment of severe dry eye in cases where punctal-plug insertion is not applicable due to an enlarged or deformed punctum. However, permanent punctal occlusion is difficult in some cases. In our aim to establish a more reliable punctal occlusion, we have devised a new surgical approach for punctal occlusion.

Patients and methods:

This study involved 20 puncta of 12 eyes of 12 patients (1 male and 11 females; mean age: 65.2 years) with severe aqueous-tear-deficient dry eye. A new surgical procedure for punctal occlusion using fibrous tissue from under the lacrimal caruncle into the diathermy-induced deepithelialized canaliculus as supporting tissue for punctal closure was performed. In all patients, the assessment of eye symptoms, as well as the condition of punctal occlusion by slit-lamp biomicroscopy, tear volume (tear-meniscus radius [TMR] measurement by meniscometry), the condition of precorneal tear film (graded by interferometry [IG]), measurement of fluorescein breakup time (FBUT), and scoring of ocular surface staining (fluorescein score of area [FSA] and density [FSD], and lissamine green score [LGS]) were performed, and the preoperative and 6-month-postoperative values were compared.

Results:

In regard to the postoperative improvement of symptoms, 11 patients showed remarkable improvement, 1 patient showed improvement, and no reopening of the closed punctum was found in any patient. Test values were all significantly improved post surgery (all: P<0.05) as compared to those prior to surgery (respective values [mean ± SD], and the pre- and postoperative P-values were: TMR (mm) [0.18±0.08; 0.56±0.28, P=0.002], IG [4.3±0.9; 2.7±0.8, P=0.009], FBUT [0.4±0.6; 4.1±2.9, P=0.004], FSA [1.6±0.7; 0.7±0.9, P=0.03], FSD [2.7±0.7; 0.6±0.7, P=0.003], and LGS [5.1±2.7; 1.1±2.1, P=0.005]). Moreover, no postoperative complications were observed.

Conclusion:

The findings of this study showed that our novel surgical procedure for punctal occlusion is highly successful and that it results in improved and more complete punctal occlusion.

KEYWORDS:

aqueous-tear-deficient dry eye; lacrimal caruncle; surgical punctal occlusion

Conflict of interest statement

Disclosure Norihiko Yokoi is a consultant for Kissei Co. Ltd., Nagano, Japan and Rohto Co. Ltd, Osaka, Japan. Shigeru Kinoshita is a consultant for Santen Pharmaceutical Co. Ltd, Osaka, Japan and Otsuka Pharmaceutical Co. Ltd., Tokyo, Japan. Aoi Komuro and Chie Sotozono report no conflicts of interest in this work.

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