title: Outcomes of 4-snip punctoplasty for severe punctal stenosis: measurement of tear meniscus height by optical coherence tomography.
abstract: OBJECTIVE
  To investigate the surgical outcome of rectangular 4-snip punctoplasty, a modification of rectangular 3-snip procedures, using objective measurements.
  
  
  METHODS
  Noncomparative case series.
  
  
  METHODS
  The medical charts of patients who underwent rectangular 4-snip punctoplasty for severe punctal stenosis with at least 6 months follow-up were reviewed. Before surgery and at 1 and 6 months after surgery, subjective evaluation of tearing was assessed using Munk scores. The size of the punctum was graded based on slit-lamp examination, and measurement of tear meniscus height was done using Fourier-domain optical coherence tomography.
  
  
  RESULTS
  A total of 45 eyes (26 patients) were studied. The subjective epiphora score was significantly reduced after surgery and maintained until 6 months after the surgery (χ2 for trend test, P<.001). The grade of the punctum size was also significantly enlarged after surgery and the enlarged punctum was maintained until 6 months after the surgery (χ2 for trend test, P<.001). The mean preoperative tear height (452.4±249.3 μm) was significantly reduced both at 1 month after surgery (341.6±207.9 μm; P=.003, paired t test) and at 6 months after surgery (362.1±212.6 μm; P=.004, paired t test). The functional success rate was 93.3% and anatomic success rate was 88.9% at 6 months after surgery.
  
  
  CONCLUSIONS
  Rectangular 4-snip punctoplasty was an anatomically and functionally effective procedure for severe punctal stenosis patients, maintaining large puncta for fairly long periods.
authors.affiliation: Department of Ophthalmology, Myongji Hospital, Kwandong University College of Medicine, Koyang, Korea.
authors.forename: Sung Eun
authors.initials: SE
authors.lastname: Kim
authors.forename: Sung Jun
authors.initials: SJ
authors.lastname: Lee
authors.forename: Sang Yeul
authors.initials: SY
authors.lastname: Lee
authors.forename: Jin Sook
authors.initials: JS
authors.lastname: Yoon
mesh_terms: D003251:Constriction, Pathologic; D003608:Dacryocystorhinostomy / Q000379:methods*; D005141:Eyelid Diseases / Q000601:surgery*; D005260:Female; D005583:Fourier Analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D013666:Tears / Q000737:chemistry*; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome