Surgical Punctal Occlusion With a High Heat-Energy Releasing Cautery Device for Severe Dry Eye With Recurrent Punctal Plug Extrusion

EMII OHBA, MURAT DOGRU, ERI HOSAKA, ASAKO YAMAZAKI, RIE ASAGA, YUKAKO TATEMATSU, YOKO OGAWA, KAZUO TSUBOTA, AND EIKI GOTO

●PURPOSE: 

 To report the rate of recanalization and the efficary 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.

●RESULTS:

Three months after surgical cauterization,symptom score decreased from 3.9±0.23 to 0.56±0.84（P<0.0001）.Logarithm of the minimal angle of  resolution best-corrected visual acuity improved from 0.11±0.30 to 0.013±0.22(P=0.003).Fluorescein staining score,rose bengal staining score, tear film break-up time,and the Schirmer teat value also improved significantly after the surgery.Only 1 of 70 punctal recanzlized 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.

Cauteries were inserted into the lacrimal punctum, the vertical portion of lacrimal canaliculus. The device then was applied in close contant with the walls of the lacrimal punctum and canaliculus until the surrounding punctal tissue color became white.

A mean of 12.2±2.2 seconds was necessary for the tissue color to change to white.

DISCUSSION

This study showed the efficacy of punctal occlusion surgery with the high heat-energy-releasing cautery device in the treatment of severe ATD with recurrent punctal plug extrusion.In all cases, lacrimal punctal were occluded successfully and no recanalization was found until 973.3±392.8 days after the surgery.

In the treatment of severe ATD dry eye patients,punctal occlusion with punctal plug is considered to be a primary approach. When recurrent punctal plug auto-extrusion is observed after punctal plug insertion, the present surgery punctal occlusion procedure with thermal cautery can be applied to the patients for relied of the symptoms and possible improvement of visual functions.

In conclusion, for severe dry eye patients with recurrent punctal plug extrusion, the present surgical punctal occlusion procedure with the high heat-energy-releasing cautery device is associated with a low punctal recanalization rate, increased tear aqueous volume, and improved visual acuity scores.