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Claire E. Fraser, Gary J. Lelli; Adjunctive Re-dilation For Early Cicatrization After Punctoplasty. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1073.
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Punctoplasty is commonly performed for epiphora due to punctal stenosis, although failures from this procedure occur anatomically (9% of patients) and functionally (36% of patients).1 To date, rates of punctoplasty failure have not been evaluated with adjunctive in-office probing for early post-procedure cicatricial changes. The purpose of this study is to evaluate punctoplasty outcomes with adjunctive in-office probing of early post-procedure cicatricial changes.
A retrospective review was conducted on all patients undergoing punctoplasty for punctal stenosis by a single surgeon (GL) between 8/1/08-8/1/09. Charts were culled for demographics, medications, allergies, blepharitis, surgical technique, postoperative visits, cicatricial changes, re-dilation, patient satisfaction, and anatomical and functional success.
Thirteen punctoplasties were performed on 12 patients during the study interval. Three were excluded for inadequate follow-up, and two for preoperative diagnosis (canaliculitis, eyelid retraction). Six women (75%) and two men (25%) with an average age of 65 years (range, 40-88) were analyzed. No patients had been previously treated with chemotherapy, two (25%) were on ocular medications and six (75%) had blepharitis. All patients underwent a 3-snip punctoplasty. On average, patients were seen for three post-procedure visits (range, 1-4) with in-office re-dilation performed on six (75%) patients. All patients reported satisfaction with the procedure at last follow-up (average 102 days; range, 21-166). Functional success was rated at "100%" in three patients (38%) and ">75%" in five (62%). Anatomic success was present in all patients.
Functional and anatomical success rates after punctoplasty may be improved by close post-procedure follow-up with in-office re-dilation for recurrent punctal cicatrization. Additional prospective evaluation is warranted to define efficacy for this adjunctive procedure.1 Shahid H et al. Factors affecting outcome of punctoplasty surgery: a review of 205 cases. Br J Ophthalmol 2008;92:1689-92.
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