Comparison of Outcomes of 3-Snip Punctoplasty Versus Simple Punctal Dilatation With Monocanalicular Intubation for Acquired Punctal Stenosis

Abstract

Purpose: 

To evaluate and compare the outcomes of invasive (rectangular 3-snip punctoplasty) versus minimally invasive (punctal dilatation with monocanalicular intubation) treatment modalities for the management of acquired punctal stenosis.

Methods: 

A retrospective, comparative, interventional case series was performed on 60 eyes of 36 patients with acquired punctal stenosis. Patients were categorized in 2 groups based on the intervention as 3-snip punctoplasty (group A) and punctal dilatation with monocanalicular intubation (group B). Qualitative and quantitative assessment for epiphora and punctal stenosis grading were performed preoperatively and postoperatively. Patients with associated canalicular and nasolacrimal duct obstructions, congenital punctal disorders, eyelid malpositions, and less than 6 months’ follow up were excluded. Anatomical and functional successes were recorded following stent extubation and at 6-month follow up. Statistical analyses were performed using the chi-square, Fisher exact, and the Mann–Whitney tests. A p value of <0.05 was considered significant.

Results: 

Ninety-nine puncta of 62 eyes of 36 patients were analyzed. Mean age at presentation was 49 and 50 years in groups A and B, respectively. Bilaterality was noted in 67% (24/36) of the patients. Epiphora was the most common presentation. Involvement of upper punctum was noted in 6% (4/62), lower punctum in 34% (21/62), and both in 60% (35/62) of eyes. At 6-month follow up, the anatomical success rate was 84% (47 out of 56 puncta) in group A, whereas 93% (40 out of 43 puncta) in group B (p = 0.29). At 6-month follow up, restenosis occurred in more number of puncta (n = 9) in group A and only in 3 puncta in group B; however, this was not statistically significant (p = 0.21). No stent-related complications were noted.

Conclusion: 

Punctal dilatation with monocanalicular intubation achieves comparable outcomes as that of 3-snip punctoplasty in patients with acquired punctal stenosis.

In Brief

Comparable outcomes were noted between a 3-snip punctoplasty versus punctal dilatation with monocanalicular intubation for acquired punctal stenosis.