Suture-assisted punctoplasty

Abstract

Purpose-To describe a surgical technique in which a suture, instead of forceps, is used to improve access for the introduction of scissors and more easily achieve an appropriately-sized punctoplasty.Materials and Methods-In this technique, a new modification of the 2-snip punctoplasty, a 6-0 polyglactin 910 suture is passed through the posterior wall of the punctum to apply traction. A video of the technique is provided.Results-This technique improves the surgical field of view and eases access for introduction of Vannas scissors into the punctum to perform the punctoplasty.Conclusions-This simple and practical modification of the 2-snip punctoplasty improves instrument access so that an appropriately-sized punctoplasty can be performed with ease.

Use of Lacrimal Symptoms Questionnaire After Punctoplasty Surgery: Retrospective Data of Technical Strategy

“…21 Punctoplasty (1, 2, or 3 snips), which involves the destruction of the normal ampulla and punctal and canalicular anatomy; this is thought to disrupt the normal pump function of the proximal lacrimal system, an essential mechanism of a normal tear drainage system. 22 The main disadvantage of this surgery is the occurrence of restenosis, related to healing of apposed cuts, as well as the disruption of canaliculus anatomy, leading to variable success rates. 23 An alternative procedure used for acquired punctal and canalicular stenosis is the insertion of silicone stent in the lacrimal duct.…”

“…The basic principles in the treatment of punctal stenosis include creating a sufficient opening, enhancing tear access from lacrimal lake to punctal opening, and preserving the function of the lacrimal pump 21 . Punctoplasty (1, 2, or 3 snips), which involves the destruction of the normal ampulla and punctal and canalicular anatomy; this is thought to disrupt the normal pump function of the proximal lacrimal system, an essential mechanism of a normal tear drainage system 22 . The main disadvantage of this surgery is the occurrence of restenosis, related to healing of apposed cuts, as well as the disruption of canaliculus anatomy, leading to variable success rates 23 .…”

Akkiz punktum stenozunda tanı, etyoloji ve tedavi seçenekleri

“…2-SP, 1-SP yapılan hastalarda takiplerde yara dudakları yaklaşma eğiliminde ise, kesinin alt kenarından kanaliküle doğru ikinci bir kesi yapılarak uygulanmıştır [19]. Daha yeni bir yayında da bir olguda sütür yardımlı 2-Snip insizyon yapılarak üçgen şeklinde doku çıkarılarak posterior ampullektomi oluşturulduğu bildirilmiştir [35].…”

“…2-SP, 1-SP yapılan hastalarda takiplerde yara dudakları yaklaşma eğiliminde ise, kesinin alt kenarından kanaliküle doğru ikinci bir kesi yapılarak uygulanmıştır[19]. Daha yeni bir yayında da bir olguda sütür yardımlı 2-Snip insizyon yapılarak üçgen şeklinde doku çıkarılarak posterior ampullektomi oluşturulduğu bildirilmiştir[35].3-SP ile posterior ampullektomiyi Graves ve ardından Thomas tanımlamıştır[19].Klasik üçgen 3-SP'de punktumdan ampullaya doğru vertikal, ardından horizontal insizyon yapılarak oluşturulan üçgen flep 3. insizyon ile eksize edilir (Resim 6b). İnsizyon bir miktar kanalikülün proksimal kısmını da içerir.…”

Efficacy and safety of super pulse CO2 laser-assisted punctoplasty with canalicular curettage in primary canaliculitis

“…The canaliculotomy procedure, however, is more invasive, causing more damage to the canaliculus and potentially causing canalicular lumen narrowing or scarring, affecting lacrimal pump function [ 9 ]. To minimize damage to the punctum and canaliculus and achieve better surgical results, many innovative methods have been proposed, such as 4-snip punctoplasty [ 10 ], 3-snip punctoplasty [ 11 ], 2-snip punctoplasty [ 12 ], and 1-snip punctoplasty [ 13 ], as well as reconstruction of the anatomic structure of the canaliculus with stents [ 8 ]. Even so, recurrent or persistent disease remains challenging for clinicians.…”