Outcomes of 4-snip punctoplasty for severe punctal stenosis: Measurement of tear meniscus height by optical coherence tomography

Sung Eun Kim, Sung Jun Lee, Sang Yeul Lee, Jinsook Yoon

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Purpose: To investigate the surgical outcome of rectangular 4-snip punctoplasty, a modification of rectangular 3-snip procedures, using objective measurements. Design: 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.

Original languageEnglish
JournalAmerican Journal of Ophthalmology
Issue number4
Publication statusPublished - 2012 Jan 1


All Science Journal Classification (ASJC) codes

  • Ophthalmology

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