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Plug or Punctoplasty (POPPY) Study: Perforated Punctal Plug Versus Three-Snip Punctoplasty in the Treatment of
John S Vekinis1, Laura Ah-Kye, Jeremy J Hoffman
1Imperial College Ophthalmic Research Unit, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Purpose:
Acquired punctal stenosis (APS) represents a common cause of epiphora and a reason for attendance at oculoplastic clinics. The three-snip punctoplasty is the mainstay of APS treatment, although perforated punctal plugs (PPPs) represent an alternative, offering reversibility and less burden on minor-operation lists. This study aimed to identify if PPPs are an acceptable alternative to the three-snip punctoplasty through comparison of functional, anatomical, and quality of life outcomes.
Methods:
Participants with APS were randomized to receive either a three-snip punctoplasty or PPP in this assessor-masked study. Participants were followed up for 1 to 2 years, with a total of 3 follow-up visits. Data collected included patient demographics, slit-lamp examination findings, punctum dimensions on punctal optical coherence tomography, and results of Watery Eye Quality of Life questionnaire assessment.
Results:
Forty-seven patients were recruited, with 25 attending the first postoperative visit and 32 providing final follow-up data via a telephone questionnaire. Both groups had significant reductions in weekly eye watering episodes and total Watery Eye Quality of Life scores, with no significant difference between groups. Only the three-snip group had a significant improvement in their simple 1 to 10 quality-of-life rating, with a significantly greater improvement than the PPP group. Following the intervention, three-snip had wider punctal optical coherence tomography and Kashkouli grade.
Conclusions:
Both punctoplasty and PPPs are effective APS interventions. Despite greater enlargement to punctal anatomy following three-snip punctoplasty, PPPs, and three-snip punctoplasty both improve epiphora, although three-snip punctoplasty may provide a greater improvement to quality of life.
