Retention Rates and Efficacy of Silicone Punctal Plugs for the Treatment of Dry Eye in Ocular Graft-Versus-Host-Disease

Abstract

Purpose : To examine the retention rates and efficacy of silicone punctal plugs for the treatment of dry eye disease (DED) in patients with ocular Graft-Versus-Host-Disease (oGVHD) compared to DED due to non-oGVHD etiologies.

Methods : We reviewed the case records of 864 patients diagnosed with dry eye disease between 2011 and 2018. The patients included in the study were symptomatic despite topical therapy and therefore required punctal plug placement. All patients had at least one follow-up, and records of ocular surface disease parameters at baseline and four-week follow-up after plug placement. We used Kaplan Meier survival test to analyze the punctal plug retention rates in oGVHD DED and non-oGVHD DED patients. We examined the efficacy of punctal plugs by analyzing changes in tear breakup time (TBUT, in secs), and corneal fluorescein staining (CFS) score (as per the National Eye Institute scale) in plug retaining patients at follow-up.

Results : The median age of the patients in the cohort was 58 years, and 606 (70%) of the patients were women. Amongst the patients, 264 (31%) patients were diagnosed with oGVHD. Punctal plug retention was significantly lower in oGVHD DED patients when compared to non-oGVHD DED patients (day 30: 89% vs. 94%, day 60: 60% vs. 81%, day 90: 43% vs. 70%, day 180: 16% vs. 43%, day 360: 7% vs. 26%, p<0.0001). The median punctal plug retention period for oGVHD DED patients was 77 days compared to 139 days in non-oGVHD DED patients. The oGVHD DED patients who retained the punctal plugs had significant improvements in CFS scores (p=0.044) and TBUT (p=0.0015) as compared to baseline measurements.

Conclusions : There are significant improvements in ocular surface disease parameters in plug retaining oGVHD DED patients. The majority of oGVHD DED patients (57%) lost punctal plugs within 90 days of placement. Therefore, it is recommended to closely follow-up with these patients to detect plug loss to ensure timely replacement of plugs or for implementing changes in the therapeutic regimen for management of the disease by the attending physician.

This is a 2020 ARVO Annual Meeting abstract.