J Korean Ophthalmol Soc.  2013 Dec;54(12):1803-1809.

Outcomes of Anterior-Side Rectangular 4-Snip Punctoplasty for Patients with Punctal Stenosis

• Kim EJ
• Shin DS
• Mun HJ
• Lee KW
• Jeong BJ

Abstract

PURPOSE
To evaluate the efficacy of anterior-side rectangular 4-snip punctoplasty, a modification of posterior ampullectomy that is currently used in patients with punctal stenosis.
METHODS
We performed a retrospective chart review of patients with punctal stenosis who underwent anterior-side rectangular 4-snip punctoplasty at our hospital. Fluorescein dye disappearance test (FDT) and questionnaire on tearing symptoms and tear meniscus height (TMH) based on spectral-domain optical coherence tomography (SD-OCT) were evaluated in preoperative and postoperative follow-up examinations of the patients. Anatomical success was defined as punctum without re-stenosis at last visit; functional success was defined as FDT grade of 0 or 1, or tearing symptom score of 2 or less.
RESULTS
A total of 44 anterior-side 4-snip punctoplasty procedures were performed in 27 patients. The average age of all subjects was 56.0 +/- 11.0 years (range, 39 to 82 years). The mean follow-up period was 9.4 months (range, 6 to 20 months). FDT, tearing symptom score (p < 0.01, Wilcoxon signed-rank test), and TMH (p < 0.01, paired t-test) were significantly decreased after surgery. Anatomical success was 40/44 cases (90.9%) and functional success was 38/44 cases (86.4%). There were no complications such as skin defect or cosmetic problems.
CONCLUSIONS
Anterior-side rectangular 4-snip punctoplasty is an effective surgical procedure for patients with punctal stenosis, maintaining functions of the lacrimal drainage system without re-stenosis of punctum.

Keyword

Anterior-side; Punctal stenosis; SD-OCT; 4-snip punctoplasty

MeSH Terms

Constriction, Pathologic*
Drainage
Fluorescein
Follow-Up Studies
Humans
Surveys and Questionnaires
Retrospective Studies
Skin
Tomography, Optical Coherence
Fluorescein

Figure

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  Figure 1. Surgical procedures of the anterior-side 4-snip punctoplasty. (A) The punctum is dilated with a punctal dilator. (B) The first, horizontal cut is made with a pair of Vanna’s scissors. (C, D) Two vertical cuts are made from the edge of the first horizontal cut. (E) Finally, the base of the flap is removed. (F) The dilated punctum is shown.

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  Figure 2. Tear meniscus height by spectral-domain optical coherence tomography. (A) Three vertical scans passing cornea, tear meniscus and lower eyelid were performed at 6 o’clock position. (B) The tear meniscus height was measured with a caliper.

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  Figure 3. Dye disappearance test, tearing symptom score and tear meniscus height were decreased significantly after surgery. (A) Dye disappearance test, (B) Tearing symptom score, (C) Tear meniscus height, * Wilcoxon signed-rank test; † paired t-test.

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  Figure 4. (A) Preoperative stenotic punctum is shown. (B) Postoperative 6 months, dilated punctum was maintained.

Reference

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