Comparative study between three-snip punctoplasty with and without mitomycin C in the management of punctal stenosis or occlusion

Abstract

Background Punctal stenosis is a progressive constriction of the puncta with resultant epiphora. One of the most effective treatment options is one- to four-snip punctoplasty with or without mitomycin C (MMC). Aim The aim of this study was to assess the effectiveness of intraoperative MMC in increasing the success rate of three-snip punctoplasty in cases of punctal stenosis. Patients and methods This is a nonrandomized interventional prospective comparative study that was conducted at the Department of Ophthalmology, Al-Hussein and Bab El Sheria Al-Azhar University Hospitals, Cairo, Egypt. It included 31 eyes of 18 patients who underwent three-snip punctoplasty. The patients were divided into two groups: group 1 (15 eyes), in which MMC was not used during surgery, and group 2 (16 eyes), in which MMC was used intraoperatively for 2 min. Complete ocular examinations were performed in all patients using the slit lamp. Punctal stenosis grading was done as follows: grade 0 (absent punctum), grade 1 (a membrane covering the papilla), grade 2 (less than average size, however, can be recognized), grade 3 (normal), grade 4 (small slit <2 mm), and grade 5 (large slit ≥2 mm). Follow-up was conducted at 1 week, 1 month, and at 3 months postoperatively. Results In group 1, five (33.3%) eyes had a total postoperative recurrent anatomical obstruction and scarring of their puncta, compared with one (6.2%) case in group 2, with a statistically significant difference (P=0.000). Conclusion MMC demonstrated a favorable, secure, and efficient adjunct treatment for punctal stenosis in the punctoplasty procedure.