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Collagen and silicone punctum plugs produce similar results, study shows
Lacrimal scintigraphy showed that both plugs significantly and equally increased the amount of tear film on the ocular surface.
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Silicone and collagen punctal plugs are equally effective in treating dry eye, according to researchers.
Dilek Dursun, MD, and colleagues at Baskent University in Turkey studied the two plugs to compare their cost and durability.
“We wanted to test if there is a difference in terms of efficacy between the two types of plugs, which could affect our preference,” Dr. Dursun told Ocular Surgery News in an e-mail interview. “Collagen plugs dissolve spontaneously from body heat after a certain time, but silicone plugs are permanent and more expensive. It’s good to test whether the patient will benefit from punctal occlusion by using collagen plugs first and then silicone, if necessary.”
The study included 24 patients with dry eye separated into two groups. Group 1 included 22 eyes implanted with collagen plugs, and group 2 included 26 eyes implanted with silicone plugs. The groups were compared against a control group of 22 eyes with no ocular disorders.
Lacrimal scintigraphy
Dr. Dursun and colleagues performed lacrimal scintigraphy to visualize and determine time to half-maximum activity (the amount of time it took testing material to clear from the ocular surface), and the percentage retention of activity on the ocular surface.
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“There is not an objective way of measuring the tear film size,” Dr. Dursun said. “In this method, 200 µCi of technetium-99m pertechnetate in 20 µL isotonic saline is applied to the ocular surface by a micropipette, just like an eye drop.”
With this method, Dr. Dursun said tear film is marked with a radioactive tracer that can produce images taken with a gamma camera, allowing them to measure the amount of ocular surface activity post-implantation.
“In the case of punctal occlusion, the drainage through the nasolacrimal duct will be blocked and more radioactive tracer will stay on the ocular surface,” she said.
Similar outcome
Schirmer’s test number 1 results, tear breakup time and rose bengal staining scores improved significantly with similar results after plug insertion in both groups, according to the study.
The mean times to half-maximum activity before plug insertion were 14.5 minutes in eyes with collagen plugs and 15.6 minutes in eyes with silicone plugs.
After plug insertions, the mean times to half-maximum activity increased significantly (P < .0001) to 24.50 minutes in the collagen group and 24.43 minutes in the silicone group, according to the results.
Mean time to half-maximum activity in the control group was 4.2 minutes.
There was a statistically significant increase (P < .0001) in activity retention percentages from 45% in both groups before insertion to 69% in the collagen group and 62% in the silicone group after insertion, the results showed.
“The collagen and silicone plugs both resulted in significant increases in aqueous tear volume, half-life of nuclear material on the ocular surface and percentage of nuclear material retention,” the researchers said.
For more information:
- Dilek Dursun, MD, can be reached at Baskent University, Faculty of Medicine, Department of Ophthalmology, 10 Sok, No. 45, Bahcelievler, 06490, Ankara, Turkey; +90-312-215-0349; fax: +90-312-223-7333; e-mail: dilek.dursun@gmail.com. Dr. Dursun and her colleagues have no financial interest in collagen or silicone punctal plugs.
- Jared Schultz is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses geographically on Europe and the Asia-Pacific region.