A brief history of punctoplasty: the 3-snip revisited

Abstract

Purpose To determine when and how to perform punctoplasty, review the history, and determine the efficacy of posterior ampullectomy. Method Retrospective analysis of 53 cases of punctal stenosis, operated by a single surgeon by means of posterior ampullectomy via 3-snips. A review of the history of the procedure from papers found with a Medline search for 1-snip, 2-snip, 3-snip, and punctoplasty. Results In all, 102 sets of notes were reviewed. The age range was from 9 to 89 years with a mean age of 56 years. A total of 74% of patients were female. We excluded 22 patients who had additional surgery and 16 patients who elected not to have surgery. There was no comment as to success or failure in four sets of notes and seven notes could not be found; these cases were also excluded. Of the remaining 53 patients, success was documented in 49 cases, or 92%. Conclusions The historical review helps explain the debate about the procedure. The retrospective review confirms that posterior ampullectomy via 3-snips is an effective procedure.

Reply to Late spontaneous anterior dislocation of an intraocular lens (IOL) with the capsular bag

“…1 We do not, however, agree with their assumptions relating to the similarities between their cases and ours and the likely aetiology in our case.…”

“…5 Caesar and McNab used a simple clinical test for diagnosis of punctal stenosis without considering the severity of stenosis among different cases. 1 There is a proposed grading system for external punctal stenosis (grades 0-2) and slit punctum (grades 4 and 5) 5 based on slit-lamp examination and the way to enter a #00 Bowman probe. This grading system is very helpful in assessing pre-and postoperative state of a stenotic punctum (Kashkouli MB, Beigi B, Astbury N. Acquired External Punctal Stenosis, surgical management and long-term follow-up.…”

Outcomes of rectangular 3-snip punctoplasty in acquired punctal stenosis: is there a need to be minimally invasive?

“…14 The triangular 3-snip is a more traditional way with one cut in the vertical canaliculus, one in the horizontal canaliculus and one cut at the base. 6,10 In contrast, the rectangular 3-snip procedure has two vertical cuts on either side of the vertical canaliculus with one cut at the base and is believed to be better than the triangular 11,15 The current study examines the role of rectangular 3-snip punctoplasty in achieving successful outcomes in a large cohort of acquired punctal stenosis.…”

“…Several modalities described in the literature include punctal dilatation, 1-snip punctoplasty, 2-snip punctoplasty, triangular 3-snip punctoplasty, rectangular 3-snip punctoplasty, 4-snip punctoplasty, punctal punching with Kelly's or Riess punch, punctoplasty with mitomycin-C, and inserting perforated punctal plugs, self-retaining bicanalicular stents, or mini-monoka. [5][6][7][8][9][10][11][12][13] Three-snip procedures in its modern form was described by Thomas in 1951. 14 The triangular 3-snip is a more traditional way with one cut in the vertical canaliculus, one in the horizontal canaliculus and one cut at the base.…”

Role of Mitomycin C as Adjunct Therapy for 3-Snip Punctoplasty in Correcting Punctal Stenosis.

“…The success rate following 3 snip punctoplasty was 92%. 3 In our study the mean age group was 38.45 year which is on the lower side of this study. Female were more involved in our study which is comparable.…”