Long-term outcomes of 3-snip versus 4-snip punctoplasty. A 10-year follow-up study

Abstract

Purpose : The aim of this retrospective study was to report the outcomes of 3-snip and 4-snip punctoplasty procedures following 10 to 12 years of follow-up in patients who had punctal stenosis, using objective measurements.

Methods : Clinical documents of 68 patients who underwent 3-snip or 4-snip punctoplasty procedures between 2009 and 2012 for punctal stenosis by a single surgeon were reviewed. Twenty-one patients were excluded due to various reasons, including missing follow-up visits, unreachable and death. Subjective evaluation of tearing was assessed using the Munk score, the size of the punctum was graded based on slit-lamp examination, and the patency of the lacrimal drainage was checked by performing irrigation with a 26-gauge canula.

Results : The age range was from 32 to 94 years, with a mean age of 74.8 years. 78.7% of patients were female. The mean follow-up time was 11.6 (10.3-12.9) years. Eighty punctoplasties were evaluated, 3-snip procedures were performed in 51 eyes (63.8%), and 4-snip in 29 eyes (36.2%). The subjective epiphora score was significantly reduced and maintained until 12 years after the surgery in 57 procedures (71.3%). However, there was no significant difference between the 3-snip procedure (70.6%) and 4-snip punctoplasty (72.4%) (p=0.88). Enlarged punctum was maintained in 78 punctoplasties (97.5%) at 12 years postoperatively, without difference between the two procedures (p=0.13). Anatomical recurrence was observed in 2 patients (2.5%), one for each procedure.

Conclusions : Three-snip and 4-snip punctoplasties are anatomically and functionally effective procedures for severe punctal stenosis patients, maintaining open puncta for fairly long periods. No statistically significant differences were observed between the outcomes of 3-snip and 4-snip procedures following a long follow-up period.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.