Punctal plugs versus artificial tears for treating primary Sjögren’s syndrome with keratoconjunctivitis SICCA: a comparative observation of their effects on visual function

Abstract

To compare the effects of treatment with punctal plugs versus artificial tears on visual function for primary Sjögren's syndrome with dry eye. Forty-two eyes of 42 patients with primary Sjögren's syndrome were enrolled and were allocated randomly into artificial tears (AT) group and punctal plugs (PP) group. Ocular Surface Disease Index (OSDI) was used, and fluorescent staining for tear film break-up time (BUT), the Schirmer test I (STI) and contrast sensitivity was performed before treatment and was repeated 3 months after treatment. A follow-up of 3 months was achieved in 40 eyes of 40 patients, including 19 eyes in artificial tears group and 21 eyes in punctal plugs group. Statistically significant improvements were observed in the OSDI scores (AT: 52.6 ± 5.7, 15.9 ± 4.2; PP: 55.8 ± 4.9, 15.1 ± 4.2), corneal fluorescein staining scores (AT: 2.60 ± 1.76, 0.30 ± 0.57; PP: 1.91 ± 1.60, 0.09 ± 0.29), STI (AT: 3.85 ± 2.03, 8.95 ± 2.72; PP: 3.36 ± 1.62, 11.41 ± 2.65), and BUT (AT: 2.60 ± 1.39, 6.00 ± 1.81; PP: 2.27 ± 1.12, 7.82 ± 1.84) after treatment compared to those of pre-treatment. The values of STI (AT: 5.10 ± 1.80; PP: 8.05 ± 1.53) and BUT (AT: 3.40 ± 1.31; PP: 5.68 ± 1.13) in punctal plugs group were significantly more improved than those in the artificial tears group. The medium- and high-level frequencies contrast sensitivities were greatly improved in simulated daylight, night, and glare disability conditions after treatment with artificial tears and punctal plugs. However, the changes in contrast sensitivity did not significantly differ between groups. Both artificial tears and punctal plugs relieved dry eye symptoms, repaired corneal lesions, enhanced tear film stability, and improved contrast sensitivity. Punctal plugs could improve tear film stability and elongate the BUT better than artificial tears.

204. A Systematic Review of Non-Pharmacological Interventions for Primary Sjögren’s Syndrome

“…The number of participants with pSS in the studies ranged from n = 42 [33] to n = 18 [29]. All studies recruited both males and females, but the numbers of males recruited to each study were low and ranged from n = 1 [30] to n = 4 [33], which is representative of the pSS population. One study [30] included participants diagnosed with pSS according to the Copenhagen [34] and San Diego Criteria [35] and the proposed European Community Study Group Criteria [36].…”

“…One study [30] included participants diagnosed with pSS according to the Copenhagen [34] and San Diego Criteria [35] and the proposed European Community Study Group Criteria [36]. The Qiu et al [33] study reported that participants were diagnosed according to the American European Consensus Criteria [3]. Mansour et al [32] recruited participants diagnosed according to the European Criteria [36].…”

“…However blinding the participants to the interventions would have been difficult with the included nonpharmacological interventions. Detection bias was deemed to be low in one study [33], in which the staff performing the assessments and analyses were blinded to the treatment allocation. Two studies were judged to be at high risk of detection bias, as the outcome assessors were not blinded [29,32].…”

“…2 for Risk of Bias Table. Sequence generation was judged to be at low risk of bias for two studies [32,33] that used computer-generated randomization schemes. The method of sequence generation was not discussed in the remaining three included studies [29 31].…”

“…The method of sequence generation was not discussed in the remaining three included studies [29 31]. Concealment of allocation was judged to be at low risk in one study only [33]. Random allocations were placed in sealed opaque envelopes marked with study identification numbers by the same clinical staff.…”