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.

目的：使用高热能烧灼设备进行泪点闭塞手术对严重干眼症和复发性泪点栓塞患者的手术疗效和术后再通率的研究报告。

设计：前瞻性干预案例系列

结果：

●手术烧灼后三个月，症状评分从3.9±0.23降低至0.56±0.84。

●最佳矫正视力的最小分辨角对数从0.11±0.30提高到0.013±0.22。

●手术后荧光染色评分，孟加拉玫瑰染色评分，泪膜破裂时间和泪液分泌实验都有显著提升。

●热灼术后，70例只有一例会复发。（1.4%）

结论：采用高热能烧灼装置进行泪点闭塞不仅与低再通率有关，而且与改善眼表湿润度和更好的视力有关。

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.

将烧灼器插入泪点（泪小管的垂直部分）。然后将该装置紧贴泪点壁和泪小管壁，直至周围的泪点组织颜色变为白色。

组织颜色变为白色所需的平均时间为12.2±2.2秒。

研究表明应用烧灼器进行泪点闭塞手术治疗伴复发性泪点挤压的严重干眼症是有效的。在任何情况下，泪点均成功闭塞。直到术后973.3±392.8天才有发现再通的。

烧灼器应用泪点闭塞手术，可减轻症状并改善视觉功能。

总之，对于严重干眼症患者，使用高温烧灼装置进行泪点手术，与较低的再通率、增加泪液量、改善视力有关。

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