Goldschleger Eye Institute.
Institute of Pathology, Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ophthalmic Plast Reconstr Surg. 2021;37(6):546-550. doi: 10.1097/IOP.0000000000001940.
To examine the clinical, imaging, and histopathologic differences between Kelly punch punctoplasty and punctal dilatation, both with mini Monoka stent insertion.
This is a prospective, comparative clinical study. Patients with bilateral punctal stenosis and for whom surgery was advised participated in the study. The right eye underwent Kelly punch punctoplasty and the left eye simple punctal dilatation, both with mini Monoka stents were participated. Data were collected and analyzed before and 3 months following the procedure and included the degree of epiphora (Munk score) and punctal size as measured by anterior segment optical coherence tomography (AC- OCT). All specimens removed by the Kelly punch punctoplasty were sent for histopathologic evaluation, including Masson's trichome muscle staining.
The study included 46 eyes of 23 patients (4 males and 19 females) whose mean age at presentation was 60.43 ± 14.81 years (range 19-84 years). There was a significant decrease in the Munk score after both punctoplasties compared with baseline values (P < 0.01, matched pairs). There were no significant differences between groups in the delta Munk score. There was a significant increase in punctal size after both procedures compared with baseline values as measured by AS-OCT. Horner-Duverney's muscle was visible in only 3 of the 23 (13.04%) specimens from patients who underwent the Kelly punch punctoplasty.
The Kelly punch punctoplasty and the simple dilator punctoplasty, both with stents, are equally effective treatments for epiphora due to acquired punctal stenosis. Only a few specimens removed during the Kelly punch method show muscle fibers.
比较经 Kelly 打孔术与单纯扩张术联合微型 Monoka 支架植入治疗泪小点狭窄的临床、影像学和组织病理学差异。
这是一项前瞻性、对照性临床研究。纳入双侧泪小点狭窄且建议手术的患者。右眼行 Kelly 打孔术，左眼行单纯扩张术，均联合微型 Monoka 支架植入。分别于术前和术后 3 个月收集并分析患者的溢泪程度（Munk 评分）和前节光学相干断层扫描（AC-OCT）测量的泪小点大小。Kelly 打孔术切除的所有标本均行组织病理学评估，包括 Masson 三色染色。
研究共纳入 23 例（4 名男性，19 名女性）46 只眼，平均年龄 60.43±14.81 岁（19~84 岁）。两种术式术后 Munk 评分均较术前显著降低（P＜0.01，配对 t 检验），但两组间差值无统计学差异。两种术式术后泪小点大小均较术前显著增大（P＜0.01，配对 t 检验）。AC-OCT 测量仅 3 例（13.04%）行 Kelly 打孔术患者的标本中可见霍纳-杜韦尼肌。
对于获得性泪小点狭窄引起的溢泪，Kelly 打孔术联合支架植入与单纯扩张术联合支架植入疗效相当。仅少数行 Kelly 打孔术患者的标本中可见肌纤维。
