Abstract Listings 2024

Purpose

The aim of this randomised controlled double-masked clinical study was to assess whether the perforated punctal plug (PPP) is an acceptable alternative to the 3-snip punctoplasty for acquired punctal stenosis (APS). We compared functional, anatomical and quality of life outcome measures for the two interventions.

Methods

Participants with punctal stenosis were randomised to receive either 3-snip punctoplasty or PPP. They were followed up over 1-2 years. Data collected included patient demographics, slit lamp examination findings including tear meniscus and Kashkouli-scale punctum size, punctum dimensions on punctal OCT, and results of the validated Watery Eye Quality of Life (WEQOL) questionnaire.

Results

47 patients were recruited and completed follow up. Both groups had clinically and statistically significant reduced estimated weekly eye watering episodes (3-snip: 54 to 23, p=0.0004. PPP: 54 to 11, p=0.008) and cumulative WEQOL scores (3-snip: 27 to 12, p=0.0002. PPP: 29 to 17.5, p=0.014) with no statistically significant difference in improvement between groups. Only the 3-snip group had significant improvement in their 1-10 quality of life rating (7 to 3, p=0.0001).Following intervention, 3-snip had wider puncta on OCT (738μm vs 491μm, p=0.008), and Kashkouli grade of punctal size (4 vs 3, p=0.0001). Tear meniscus height was similarly reduced after both treatments.

Conclusion

Both punctoplasty and PPPs are effective interventions in the treatment of APS. Despite greater enlargement to punctal anatomy following 3-snip punctoplasty, PPPs and 3-snip punctoplasty both similarly improve epiphora though 3-snip punctoplasty may have a greater improvement to quality of life. PPP can offer a potentially quicker and less invasive alternative to 3-snip punctoplasty with similarly good results.

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