Download Punctual plug and dry eye after photorefractive keratectomy Results

Punctual plug and dry eye after photorefractive keratectomy
Autors: Marcos Alonso Garcia, Daniela Akemi Miyamoto, Luiz Humberto Teixeira Bóro, Gustavo
Victor, Clarissa Machado Odloak, Gustav Arno Auwaerter, Paloma Juni G.Campos
.
Cornea Sector – Department of Ofthalmology
Ana Costa Hospital of Santos - HAC
There is no financial interest by the author and coauthor’s in this poster issue
Treatment of Pseudophakic CME with a Single Intravitreal
Punctual plug
and
dry
eye
after
photorefractive
keratectomy
Triamcinolone Acetonide Injection
Purpose
To value the efficiency of the use of collagen plug at the tear point in patients who
presented diagnosis of dry eye, at the PRK post-operative with mitomicin C.
Treatment of Pseudophakic CME with a Single Intravitreal
Punctual plug
and
dry
eye
after
photorefractive
keratectomy
Triamcinolone Acetonide Injection
Method
It is a prospective, randomized with control group study. Initially, we select 30 eyes (15
patients) that will be valued in the seventh day of post-operative. However, due to alterations
at the reepithelialization, and loss of follow up, we value 14 eyes (7 patients), who presented
symptoms of dry eye, Break Up Time (BUT) less than 5 seconds or basal secretion test <5mm
at 5 minutes or Schirmer I test <10mm at 5 minutes at the twentieth day of PRK post-operative
with Mitomicin C. The PRK was made with LADAR Vision 4000 and mitomicin C 0,02 % for 30
seconds. The values of corneal ablation varied between 40,6 and 79,8 micra. The patients does
not presents ocular diseases or dry eye at the beginning of study. The eyes were randomized in
two groups. Group 1: eyes that received plug in the tear inferior point (0.3mm diameter x
1.5mm length), Control group: counter side eyes of group 1, which not received the plug. In
the post-operative all the eyes received the same treatment. For subjective evaluation, the
patients answered a daily questionnaire for one week. The objective evaluation was made
with BUT, basal secretion and Schirmer I tests. The patients were re-examined after seven
days.
.
Treatment of Pseudophakic CME with a Single Intravitreal
Punctual plug
and
dry
eye
after
photorefractive
keratectomy
Triamcinolone Acetonide Injection
Results
P atient
1
2
3
4
5
6
7
T able 1: O bjective evaluation
B UT of eyes without plug (s econds )
B UT of eyes with plug (s econds )
B efore (day 1)
After (day 7)
B efore plug (day 1)
After plug (day 7)
3
3
3
3
4
4
4
4
4
4
3
4
3
3
4
4
4
4
4
5
4
4
4
5
3
4
3
5
Treatment of Pseudophakic CME with a Single Intravitreal
Punctual plug
and
dry
eye
after
photorefractive
keratectomy
Triamcinolone Acetonide Injection
Results
Table: Subjective evaluation: Ardency
Patients
1
2
3
4
5
6
7
with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug
Day
before plug
2
2
0
0
0
0
2
2
0
0
0
0
1
1
day1
1
2
0
0
0
0
2
1
0
0
0
0
1
1
day2
1
2
1
0
1
0
1
2
0
0
0
0
0
1
day3
2
1
1
0
0
0
1
2
0
0
0
0
0
1
day4
1
1
1
0
0
0
1
1
0
0
0
0
0
1
day5
1
1
0
0
0
0
1
1
0
0
0
0
0
1
day6
1
1
0
0
0
0
1
1
0
0
0
0
0
1
day7
1
1
0
0
0
0
1
1
0
0
0
0
1
1
Table: Subjective evaluation: Foreign Body Sensation
Patients
1
2
3
4
5
6
7
Day
with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug
before plug
2
1
0
0
0
0
2
1
0
0
0
0
1
1
day1
3
3
0
0
3
0
2
1
1
0
0
0
1
2
day2
2
3
1
0
2
0
1
1
0
0
0
0
1
1
day3
2
2
0
0
0
0
1
1
0
0
0
0
0
1
day4
1
1
0
0
0
0
1
1
0
0
0
0
0
1
day5
1
1
0
0
0
0
0
1
0
0
0
0
0
1
day6
1
1
0
0
0
0
0
0
0
0
0
0
0
0
day7
1
1
0
0
0
0
0
0
0
0
0
0
0
0
Subtitle: Intensity of symptoms 0(none), 1(weak), 2(middle), 3(strong), 4(very strong)
Treatment of Pseudophakic CME with a Single Intravitreal
Punctual plugTriamcinolone
and dry eye after
photorefractive
keratectomy
Acetonide Injection
Results
Table: Subjective evaluation: Blurred vision
Patients
1
2
3
4
5
6
7
with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug
Day
before plug
1
2
1
1
0
0
0
1
0
0
0
0
1
1
day1
1
2
1
0
0
0
0
1
0
0
0
0
1
1
day2
2
3
0
0
1
0
0
0
0
0
0
0
1
1
day3
1
1
0
0
0
0
0
0
0
0
0
0
0
1
day4
0
0
0
0
0
0
0
0
0
0
0
0
0
1
day5
0
0
0
0
0
0
0
0
0
0
0
0
0
1
day6
0
0
1
1
0
0
0
0
0
0
0
0
0
1
day7
0
0
1
1
0
0
0
0
0
0
0
0
1
1
Table: Subjective evaluation: Blurred vision at dry atmosphere
Patients
1
2
3
4
5
6
7
Day
with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug
before plug
1
1
2
2
1
1
0
0
0
0
2
2
2
2
day1
1
2
1
2
1
1
0
0
0
0
2
2
1
2
day2
2
3
0
0
1
1
0
0
0
0
1
2
2
2
day3
1
1
0
0
1
1
0
0
0
0
1
2
1
2
day4
0
0
0
0
1
1
0
0
0
0
1
2
1
1
day5
0
0
0
0
1
1
0
0
0
0
2
1
1
1
day6
0
0
0
1
1
1
0
0
0
0
1
1
1
1
day7
0
0
0
0
1
1
0
0
0
0
1
1
1
1
Subtitle: Intensity of symptoms 0(none), 1(weak), 2(middle), 3(strong), 4(very strong)
Treatment of Pseudophakic CME with a Single Intravitreal
Punctual plugTriamcinolone
and dry eye after
photorefractive
keratectomy
Acetonide Injection
Results
Table: Subjective evaluation: Photophobia
Patients
1
2
3
4
5
6
7
Day
with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug
before plug
1
1
1
0
3
3
0
1
0
0
0
0
2
1
day1
1
1
1
0
3
3
0
1
0
0
0
0
2
1
day2
1
1
0
0
3
3
0
1
0
0
0
0
1
1
day3
0
0
0
0
2
2
0
1
0
0
0
0
1
1
day4
0
0
0
0
2
2
0
1
0
0
0
0
1
1
day5
0
0
0
0
2
2
0
0
0
0
0
0
1
1
day6
0
0
0
0
2
2
0
0
0
0
0
0
1
1
day7
0
0
0
0
2
2
0
0
0
0
0
0
2
1
Table: Subjective evaluation: Tearing
Patients
1
2
3
4
5
6
7
Day
with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug with plug without plug
before plug
1
2
1
0
0
0
0
1
0
0
0
1
1
1
day1
1
1
1
0
2
0
0
1
0
0
0
1
1
1
day2
1
1
0
0
1
0
0
1
0
0
0
1
1
1
day3
1
1
0
0
0
0
0
1
0
0
0
1
0
1
day4
0
0
0
0
0
0
0
1
0
0
0
1
0
1
day5
0
0
0
0
0
0
0
1
0
0
1
1
0
1
day6
0
0
0
0
0
0
0
1
0
0
0
0
0
0
day7
0
0
0
0
0
0
0
1
0
0
0
0
0
0
Subtitle: Intensity of symptoms 0(none), 1(weak), 2(middle), 3(strong), 4(very strong)
Punctual plug and dry eye after photorefractive keratectomy
Results
All the Schirmer I tests were > 10mm at 5 minutes and basal secretion tests were > 5mm at 5
minutes. The objective evaluation showed few differences in the Break Up Time after seven days
of the use of plug. This fact can be explained by the absorption of the plug, which would be
efficient in the first days. At the subjective evaluation we saw that five of seven patients had
improvements in some symptoms, in the eyes with plug. The Patient 1 had ardency symptom
(middle intensity) before plug, improving for weak intensity at the first day of plug, whereas in the
eye without plug improved at the third day. The patient 2 felt blurred vision in dry atmosphere
with middle intensity, improving for weak intensity in the first day of plug, and in another eye it
improved in the third day. ) At the beginning, the patient 4 felt ardency symptom (middle
intensity, becoming weak in the second day of plug, and at the forth day in the other. This patient
reported foreign body sensation that improved at the second day of plug and at the sixth day in
the eye without plug. The patient 6 related blurred vision in dry atmosphere (middle intensity),
improving for weak at the second day, whereas in the eye without plug this symptom remained
until the fifth day. The patient 7 felt weak symptom of ardency that disappeared at the second
day in the eye with plug and at the seventh day in the other eye. He also felt blurred vision in dry
atmosphere that improved at the third day in eye with plug and at the sixth day in the other eye.
The patients 3 and 5 did not report differences in the both eyes.
Punctual plug and dry eye after photorefractive keratectomy
Conclusions
In accordance with this study, we check that the use of collagen plug at PRK postoperative did not demonstrate great changes in the objective analysis of dry eye.
However at the subjective evaluation we saw significant improvements at the initials
days after its introduction. In the fact we need other studies, with more expressive
number of patients, for better conclusions.