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

Norihiko Yokoi,1 Aoi Komuro,1 Chie Sotozono,1 Shigeru Kinoshita2 1Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan; 2Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan Purpose: Surgical...

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Autores principales:	Yokoi N, Komuro A, Sotozono C, Kinoshita S
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	surgical punctal occlusion aqueous-tear-deficient dry eye lacrimal caruncle Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/5a56b0a2c6de474ea0e49de6914fa318
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spelling	oai:doaj.org-article:5a56b0a2c6de474ea0e49de6914fa3182021-12-02T06:34:21ZA new surgical approach for punctal occlusion using fibrous tissue from under the lacrimal caruncle1177-5483https://doaj.org/article/5a56b0a2c6de474ea0e49de6914fa3182018-03-01T00:00:00Zhttps://www.dovepress.com/a-new-surgical-approach-for-punctal-occlusion-using-fibrous-tissue-fro-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Norihiko Yokoi,1 Aoi Komuro,1 Chie Sotozono,1 Shigeru Kinoshita2 1Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan; 2Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan 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: surgical punctal occlusion, aqueous-tear-deficient dry eye, lacrimal caruncleYokoi NKomuro ASotozono CKinoshita SDove Medical Pressarticlesurgical punctal occlusionaqueous-tear-deficient dry eyelacrimal caruncleOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 12, Pp 463-472 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	surgical punctal occlusion aqueous-tear-deficient dry eye lacrimal caruncle Ophthalmology RE1-994
spellingShingle	surgical punctal occlusion aqueous-tear-deficient dry eye lacrimal caruncle Ophthalmology RE1-994 Yokoi N Komuro A Sotozono C Kinoshita S A new surgical approach for punctal occlusion using fibrous tissue from under the lacrimal caruncle
description	Norihiko Yokoi,1 Aoi Komuro,1 Chie Sotozono,1 Shigeru Kinoshita2 1Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan; 2Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan 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: surgical punctal occlusion, aqueous-tear-deficient dry eye, lacrimal caruncle
format	article
author	Yokoi N Komuro A Sotozono C Kinoshita S
author_facet	Yokoi N Komuro A Sotozono C Kinoshita S
author_sort	Yokoi N
title	A new surgical approach for punctal occlusion using fibrous tissue from under the lacrimal caruncle
title_short	A new surgical approach for punctal occlusion using fibrous tissue from under the lacrimal caruncle
title_full	A new surgical approach for punctal occlusion using fibrous tissue from under the lacrimal caruncle
title_fullStr	A new surgical approach for punctal occlusion using fibrous tissue from under the lacrimal caruncle
title_full_unstemmed	A new surgical approach for punctal occlusion using fibrous tissue from under the lacrimal caruncle
title_sort	new surgical approach for punctal occlusion using fibrous tissue from under the lacrimal caruncle
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/5a56b0a2c6de474ea0e49de6914fa318
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A new surgical approach for punctal occlusion using fibrous tissue from under the lacrimal caruncle

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