Ophthalmology. 2006 Oct;113(10):1859.e1-6. doi: 10.1016/j.ophtha.2006.05.032. Epub 2006 Aug 22.
To characterize and describe the management of complications seen in patients who have undergone insertion of the SmartPlug permanent punctal plug.
Retrospective case series.
Patients who experienced complications after SmartPlug insertion and were treated by 1 of 18 ophthalmic plastic and reconstructive surgeons between January 2004 and October 2005.
Presenting symptoms and signs and the management of complications were analyzed.
Prevalences of canaliculitis and dacryocystitis, tearing at presentation, and outcome of conservative and/or surgical management of the SmartPlug complications.
Twenty-eight patients were included in the study; 13 had bilateral involvement. On initial presentation, 18 patients had inflammation, including 17 with canaliculitis and 1 with recurrent acute dacryocystitis. Ten patients had little or no inflammation; all 10 had tearing of the involved eye(s). In 5 patients, complications resolved after office irrigation of the lacrimal drainage system; in a sixth patient, silicone intubation was performed as well. Canaliculotomy was performed in 13 patients (bilateral in 3) and combined with silicone intubation (3 patients). Canaliculotomy was planned in an additional 2 patients. Canaliculitis in 1 patient responded to a course of oral antibiotics; the plug was massaged out of the punctum in a retrograde fashion in another patient. In still another patient, the plugs expressed themselves at the time of planned canaliculotomy. In 4 patients, dacryocystorhinostomy (DCR) with silicone intubation was necessary. Two additional patients refused further treatment including DCR and canaliculotomy; both were lost to follow-up.
Canaliculitis, acute dacryocystitis, and tearing may be seen in patients who have had SmartPlugs and may be managed by removal of the plug. A trial of topical and oral broad-spectrum antibiotics followed by retrograde massage of the plug through the canaliculus may be helpful should plug removal be deemed appropriate. If conservative measures fail, canaliculotomy with removal of the plug may be considered; DCR may be necessary. Although lacrimal irrigation may resolve the problem, irrigation also may dislodge the plug from its canalicular position and cause permanent obstruction of the lacrimal drainage system.
对接受SmartPlug永久性泪点塞植入术患者出现的并发症进行特征描述及处理方法介绍。
回顾性病例系列研究。
2004年1月至2005年10月期间，18位眼科整形与重建外科医生中，有1位医生为经历SmartPlug植入术后出现并发症的患者进行治疗。
分析患者的症状体征及并发症处理方法。
泪小管炎和泪囊炎的患病率、就诊时流泪情况以及SmartPlug并发症保守和/或手术治疗的结果。
本研究纳入28例患者，其中13例为双侧病变。初诊时，18例患者有炎症，包括17例泪小管炎和1例复发性急性泪囊炎。10例患者炎症轻微或无炎症，所有10例受累眼均有流泪症状。5例患者经门诊泪道冲洗后并发症缓解，第6例患者同时进行了硅胶插管。13例患者（3例为双侧）接受了泪小管切开术，并联合硅胶插管（3例）。另有2例患者计划进行泪小管切开术。1例患者的泪小管炎经口服抗生素治疗有效；另1例患者通过逆行方式将泪点塞从泪点挤出。还有1例患者在计划进行泪小管切开术时，泪点塞自行排出。4例患者需要进行泪囊鼻腔吻合术（DCR）并联合硅胶插管。另外2例患者拒绝进一步治疗，包括DCR和泪小管切开术，均失访。
接受SmartPlug植入术的患者可能出现泪小管炎、急性泪囊炎和流泪症状，可通过取出泪点塞进行处理。若认为取出泪点塞合适，可先试用局部和口服广谱抗生素，随后通过泪小管对泪点塞进行逆行按摩。若保守治疗失败，可考虑行泪小管切开术并取出泪点塞；可能需要进行DCR。虽然泪道冲洗可能解决问题，但冲洗也可能使泪点塞从泪小管位置移位，导致泪道系统永久性阻塞。
