Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA.
Cornea. 2021 Feb 1;40(2):168-171. doi: 10.1097/ICO.0000000000002384.
To evaluate the long-term outcomes of surgical occlusion of lacrimal puncta using thermal cautery in the management of ocular surface diseases.
We reviewed medical records of 80 consecutive patients from a single academic center who underwent punctal cauterization. Patient demographics, ocular history, symptoms, and signs of ocular surface diseases pre- and post-cauterization were recorded.
A total of 80 patients (171 puncta) were included, with an average age of 59 years and a follow-up duration of 27 months. The most common ocular morbidity was ocular graft-versus-host disease (n = 36), followed by primary keratoconjunctivitis sicca (n = 15). Indications for punctal cauterization included plug loss (n = 51), difficulty in plug fitting (n = 11), plug-related complications (n = 6), recanalization of previous cauterization (n = 7), and severe ocular surface disease requiring permanent punctal closure (n = 4). After punctal cauterization, the percentage of eyes with severe (21%) and moderate (25%) dry eye decreased significantly (8% and 19% at 3 months and 6% and 17% at 12 months, P = 0.0006). Fifty-four percent of patients reported improvement in their symptoms. The rate of recanalization was 21% during the follow-up period. The use of topical corticosteroids was associated with higher recanalization rate. Associated complications were limited to temporary pain and swelling.
Punctal cauterization is an effective modality in treating severe ocular surface diseases in patients who repeatedly lose punctal plugs, and it can be easily performed in a clinic setting without major complications. However, cauterization may need to be repeated in up to a quarter of cases because of recanalization.
评估热凝法封闭泪小点治疗眼表疾病的长期效果。
我们回顾了单中心 80 例连续患者的病历，这些患者均接受了泪小点烧灼治疗。记录了患者的人口统计学资料、眼部病史、术前和术后的症状和眼表疾病体征。
共纳入 80 例患者（171 个泪小点），平均年龄 59 岁，随访时间为 27 个月。最常见的眼部疾病是移植物抗宿主病（n = 36），其次是原发性干燥性角结膜炎（n = 15）。泪小点烧灼的适应证包括：义管脱落（n = 51）、义管适配困难（n = 11）、义管相关并发症（n = 6）、先前烧灼后再通（n = 7）以及严重眼表疾病需要永久性泪小点封闭（n = 4）。泪小点烧灼后，严重（21%）和中度（25%）干眼的眼数明显减少（3 个月时分别为 8%和 19%，12 个月时分别为 6%和 17%，P = 0.0006）。54%的患者报告症状改善。随访期间再通率为 21%。局部皮质类固醇的使用与更高的再通率相关。相关并发症仅限于短暂的疼痛和肿胀。
在反复失去泪小点义管的患者中，泪小点烧灼是治疗严重眼表疾病的有效方法，并且可以在诊所环境中轻松进行，没有重大并发症。然而，由于再通，多达四分之一的病例可能需要重复烧灼。
