Yokoi Norihiko, Komuro Aoi, Sotozono Chie, Kinoshita Shigeru
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Clin Ophthalmol. 2018 Mar 6;12:463-472. doi: 10.2147/OPTH.S155209. eCollection 2018.
Surgical punctal occlusion is indispensable for the treatment of severe dry eye in cases where punctal-plug insertion is not applicable due to an enlarged or deformed punctum. However, permanent punctal occlusion is difficult in some cases. In our aim to establish a more reliable punctal occlusion, we have devised a new surgical approach for punctal occlusion.
This study involved 20 puncta of 12 eyes of 12 patients (1 male and 11 females; mean age: 65.2 years) with severe aqueous-tear-deficient dry eye. A new surgical procedure for punctal occlusion using fibrous tissue from under the lacrimal caruncle into the diathermy-induced deepithelialized canaliculus as supporting tissue for punctal closure was performed. In all patients, the assessment of eye symptoms, as well as the condition of punctal occlusion by slit-lamp biomicroscopy, tear volume (tear-meniscus radius [TMR] measurement by meniscometry), the condition of precorneal tear film (graded by interferometry [IG]), measurement of fluorescein breakup time (FBUT), and scoring of ocular surface staining (fluorescein score of area [FSA] and density [FSD], and lissamine green score [LGS]) were performed, and the preoperative and 6-month-postoperative values were compared.
In regard to the postoperative improvement of symptoms, 11 patients showed remarkable improvement, 1 patient showed improvement, and no reopening of the closed punctum was found in any patient. Test values were all significantly improved post surgery (all: <0.05) as compared to those prior to surgery (respective values [mean ± SD], and the pre- and postoperative -values were: TMR (mm) [0.18±0.08; 0.56±0.28, =0.002], IG [4.3±0.9; 2.7±0.8, =0.009], FBUT [0.4±0.6; 4.1±2.9, =0.004], FSA [1.6±0.7; 0.7±0.9, =0.03], FSD [2.7±0.7; 0.6±0.7, =0.003], and LGS [5.1±2.7; 1.1±2.1, =0.005]). Moreover, no postoperative complications were observed.
The findings of this study showed that our novel surgical procedure for punctal occlusion is highly successful and that it results in improved and more complete punctal occlusion.
对于因泪点扩大或变形而无法插入泪点塞的严重干眼症病例，手术性泪点封闭是治疗的必要手段。然而，在某些情况下永久性泪点封闭较为困难。为了建立一种更可靠的泪点封闭方法，我们设计了一种新的泪点封闭手术方法。
本研究纳入了12例患者（1例男性，11例女性；平均年龄：65.2岁）共12只眼的20个泪点，这些患者均患有严重的水样泪液缺乏型干眼症。采用一种新的泪点封闭手术方法，将泪阜下方的纤维组织植入透热疗法诱导的去上皮化泪小管，作为泪点封闭的支撑组织。对所有患者进行眼部症状评估，以及通过裂隙灯显微镜检查评估泪点封闭情况、泪液量（通过泪液弯月面半径测量法测量泪液弯月面半径 [TMR]）、角膜前泪膜情况（通过干涉测量法分级 [IG]）、荧光素破裂时间测量（FBUT）以及眼表染色评分（荧光素面积评分 [FSA] 和密度评分 [FSD]，以及丽丝胺绿评分 [LGS]），并比较术前和术后6个月的值。
关于术后症状改善情况，11例患者有显著改善，1例患者有改善，且未发现任何患者的封闭泪点重新开放。与手术前相比，所有测试值在术后均有显著改善（均为：<0.05）（各自的值 [平均值±标准差]，术前和术后的值分别为：TMR（mm）[0.18±0.08；0.56±0.28，P = 0.002]，IG [4.3±0.9；2.7±0.8，P = 0.009]，FBUT [0.4±0.6；4.1±2.9，P = 0.004]，FSA [1.6±0.7；0.7±0.9，P = 0.03]，FSD [2.7±0.7；0.6±0.7，P = 0.003]，以及LGS [5.1±2.7；1.1±2.1，P = 0.005]）。此外，未观察到术后并发症。
本研究结果表明，我们新的泪点封闭手术方法非常成功，可实现更好且更完全的泪点封闭。
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