Dr. DeepakChoudhury, Dr. Jagdish Prasad Rout, Dr. PramodKumar Sharma, Dr. Kanhei Charan Tudu, Dr.Sharmistha Behera
PRESENTING AUTHOR: Dr. Deepak Choudhury
CHIEF AUTHOR: Dr. J P Rout
CO AUTHOR: Prof. Dr. J Dora, Dr. K C Tudu, Dr. S Behera, Dr. P K Sharma, Veer Surendra Sai Institute of Medical Science and Research, Burla, Odisha.
FINANCIAL DISCLAIMER
The authors have no financial interest in any materials discussed in the presentation.
Introduction
- Stenosis of lacrimal punctum has numerous causes, including infection with herpes simplex, herpes zoster, chlamydia, actinomyces & HPV.
- It can be caused by rare systemic conditions such as porphyria cutanea tarda and acrodermatitis enteropathica, direct and thermal trauma or be secondary to topical or systemic chemotherapy & irradiation.
- The surgery involved in attempting to resolve the stenosis is now commonly described as a 1-, 2-, or 3-snip procedure.
- These descriptions imply the exact number of cuts required to perform the procedure
Aim:-
- To assess the efficacy of intraoperative mitomycin C in improving the success rate of the 3-snip punctoplasty procedure for punctual stenosis.
Material & Methods :-
- Prospective study of 36 eyes of 22 patients who underwent 3-snip punctoplasty in the Ophthalmology OT of a tertiary health care centre in western Odisha.
– Study design:- Prospective study
-Study period:- 13 months (April 2014 to April 2015)
Methods:-
- Detailed history taking
- Examination
- Laboratory investigations
- 1ml of 2% lignocaine with 1 : 10 0000 epinephrine injected subcutaneously below lower punctum.
- Punctum dilated sufficiently to allow the posterior wall of ampulla to be grasped with toothed microforceps.
- Vannas scissors used to excise posterior wall of the ampulla with three snips, the first two downwards on each side of the forceps and the third across the bottom.
- The procedure was done without mitomycin C in 14 eyes and with mitomycin C 0.01% intraoperatively for 2 min in 22 eyes under local anaesthesia.
Results:-
- 36 eyes of 22 patients underwent 3-snip punctoplasty.
- Age range was from 16 to 63 years
- 2 % patients were female
- In group without mitomycin c, 4 of 14 (28.6%) eyes had complete anatomic obstruction and scarring of their puncta after surgery
- All 22 eyes in group with mitomycin c had patent puncta and there was no scarring following surgery.
- The difference was statistically significant (P=0.03).
- No significant complications were observed after surgery.
Fig- 1:- 3 snip punctoplasty
Discussion:-
- Ceasar et al found in a study the age range was from 9 to 89 years with a mean of 56 years. A total of 74% of patients were female. The success rate following 3 snip punctoplasty was 92%.1
- According to Maluf et al Mitomycin C appears to be a safe and effective adjunct therapy in correcting punctal stenosis
Conclusion:-
- Mitomycin C appears to be a safe and effective adjunct therapy in correcting punctal stenosis.
References:-
- Caesar H, McNab A. A brief history of punctoplasty: the 3-snip revisited. Eye. 2005; 19: 16-8.
- Maluf R, Hamus N, Awwad S. Mitomycin C as adjunct therapy in correcting punctal stenosis. Ophthal Plast Reconstr Surg.2002 Jul;18(4):285-8.