Evaluation of implanted perforated lacrimal punctal plugs using anterior segment optical coherence tomography

Raafat Mohyeldeen Abdelrahman Abdallah, Ahmed Mohamed Kamal Elshafei, Heba Radi AttaAllah, Raafat Mohyeldeen Abdelrahman Abdallah, Ahmed Mohamed Kamal Elshafei, Heba Radi AttaAllah

Abstract

Purpose: Evaluation of the patency and position of perforated lacrimal punctal plugs implanted for treating punctal stenosis together with quantitative assessment of the precorneal tear film using anterior segment optical coherence tomography (AS-OCT).

Methods: In a prospective study, the lower punctum of 54 eyes of 29 patients implanted with perforated punctal plugs were examined using AS-OCT during the early postoperative period. Preoperative tear meniscus height (TMH) and tear meniscus area (TMA) were evaluated. Postoperatively, the patency of the plug, its position, TMH and TMA were evaluated, and the results were correlated with postoperative epiphora. Munk scale was used for epiphora grading.

Results: Using AS-OCT, 48 (88.9%) plugs were found in proper position while 6 (11.1%) were rotated. The lumen of the plugs was completely patent in 47 (87%) plugs, partially obstructed in 2 (3.7%) plugs and completely occluded in 5 (9.2%) plugs. There was a statistically significant postoperative decrease of TMH and TMA (P < 0.001) and postoperative epiphora Munk score (P < 0.001).

Conclusion: AS-OCT is a valuable, reliable, and noninvasive investigative tool that can detect the proper positioning, patency, and contents of the implanted perforated lacrimal punctal plugs in addition to measurement of TMH and TMA. Trial registration ClinicalTrials.gov ID: NCT04624022, https://ichgcp.net/clinical-trials-registry/NCT04624022.

Keywords: AS-OCT; Perforated plugs; Plugs.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Preoperative and postoperative measurement of tear meniscus height (TMH) and area (TMA). a Infrared image showing line scan passing through the junction between the lower eye lid and the inferior cornea at the 6 o’clock location. b Preoperative AS-OCT scan showing lower TMH: a line joining upper cornea-meniscus junction to the lower eyelid-meniscus junction (white line, measuring 724 µm). c Preoperative AS-OCT scan showing the TMA (hashed triangle, measuring 0.288 mm2). d Postoperative OCT scan showing TMH (white line 282 µm) and TMA (hashed triangle, 0.021 mm2)
Fig. 2
Fig. 2
Preoperative and postoperative AS-OCT measurements of tear meniscus height (TMH) and area (TMA). a Preoperative scan showing lower TMH (white line, measuring 769 µm) and TMA (hashed triangle, measuring 0.196 mm2). b Postoperative scan showing TMH 408 µm and TMA 0.061 mm2
Fig. 3
Fig. 3
Plug position imaged by AS-OCT. a The plug in proper position and fluid level not reaching the top. b Rotated plug with debris within its lumen
Fig. 4
Fig. 4
Patency of the plug by AS-OCT. a Properly placed patent plug. b Partially occluded. c Total superficial occlusion (blood clot) demonstrated by arrow and the plug is deeply impacted. d Deeply occluded plug and tear fluid reaching the top of the plug

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Source: PubMed

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