Acquired external punctal stenosis: surgical management and long-term follow-up.
OBJECTIVE
To introduce and assess the results of a long-term follow-up of a one-snip punctoplasty with monocanalicular stent (Mini Monoka) for acquired external punctal stenosis (AEPS) with and without associated internal punctal and canalicular stenosis.


METHODS
Prospective non-comparative interventional case series.


METHODS
Thirty-five eligible patients (53 eyes) with AEPS underwent a horizontal one-snip punctoplasty and Mini Monoka tube insertion by or under supervision of a consultant Oculoplastic surgeon from June 1999 to May 2002. Diagnostic probing and irrigation were performed before operation and after operation at the last follow-up. Patients with canalicular obstruction, nasolacrimal duct stenosis and obstruction, and those with less than 6 months' follow-up were excluded. The Chi-square (X(2)), Fisher's exact, Pearson correlation, and multiple logistic regression analysis tests, with 95% confidence interval when appropriate, were used for statistical analysis.


RESULTS
The age range was 39 to 90 years (mean: 67.2, SD: 11.8, SE: 2). Twenty-seven patients (77.1%) were female. There was a normal canalicular system in 21 (39.6%), lower canalicular stenosis in 10 (18.8%), and internal punctal stenosis in 22 (41.5%) eyes. Postoperative follow-up was from 6 to 41 months (mean: 18.5, SD: 9.2, SE: 1.2). There was a 77.4% complete functional success, 7.5% partial functional success, and 96.2% anatomical success at the last follow-up. The success rate was not significantly different between the eyes with and without preoperative internal punctal and canalicular stenosis (p = 0.4). The lower success rate was significantly correlated with a final abnormal probing and irrigation (p < 0.01).


CONCLUSIONS
The use of a monocanalicular Mini Monoka stent together with a one-snip punctoplasty is helpful to prevent the recurrence of punctal stenosis in the healing phase and addresses the associated internal punctal and canalicular stenosis.
Kashkouli
Mohsen Bahmani
MB
Associate Professor, Eye Research Center, Oculoplastic Unit, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Beigi
Bijan
B
Astbury
Nick
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic; D003608:Dacryocystorhinostomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007765:Lacrimal Apparatus; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D055502:Secondary Prevention; D015607:Stents; D016896:Treatment Outcome; D014945:Wound Healing