Punctal plugs, cooling minimize dry eye, thermal trauma after phaco

The ‘best bandage’ following phaco is the patient’s own tear film, which temporary punctal plugs, speaker says.

Sameh Issa

Temporary punctal plugs applied at the end of phacoemulsification prevented postoperative dry eye syndrome and stabilized tear breakup time, a surgeon reported.

In addition, a cooling system for biaxial phacoemulsification enabled the reduction of incision size, further enhancing safety, Sameh Issa, MD, PhD, said at the European Society of Cataract and Refractive Surgeons meeting in Vienna.

Dr. Issa elucidated study results showing changes in the tear film after phacoemulsification with and without Duraplugs (EagleVision) inserted in the upper punctum.

“We are convinced now that the best bandage to use after phaco is the patient’s own tear film preserved by temporary punctal plugs,” Dr. Issa said in an email interview.

Punctal plugs may be used after surgery when signs and symptoms of dry eye appear. However, the plugs are more effective when they are inserted at the end of surgery, Dr. Issa said.

A cooling system designed by Dr. Issa and manufactured by Surgicon AMT reduced thermal trauma to the corneal incision and adjacent conjunctiva, Dr. Issa said.

“The cooling system allowed us to decrease incision size to 1.6 mm used in the second study group, which plays an important role in preventing dry eye,” he said. “In addition to that, this effect may be related to the cooled balanced salt solution that flows on the conjunctiva and corneal incision, preventing thermal trauma that may lead to dry eye.”

Patients, methods, results

The study, coauthored by Dr. Issa and colleagues Lara Nehmeh, Lara Youssef, Reem Moustafa and Mhd Anas Wahba, included 71 eyes divided into two study groups and two control groups. The first study group included 26 eyes that underwent coaxial phacoemulsification with punctal plugs. The second study group included 17 eyes that underwent biaxial phacoemulsification with plugs.

The first control group included 15 eyes that underwent coaxial phacoemulsification without plugs. The second control group included 13 eyes that underwent biaxial phacoemulsification without plugs.

Overall mean tear breakup time was 10.4 seconds before surgery and 8.1 seconds after surgery. The decrease was statistically significant (P < .001).

The first and third groups had similar average preoperative tear breakup time (9.4 seconds and 9.1 seconds, respectively). At 1 month, mean tear breakup time was 10.3 seconds in the first group and 5.3 seconds in the third group (P < .01).

One day after surgery, mean tear breakup time was 7.9 seconds in the second group and 9.6 seconds in the fourth group. At 1 month, mean tear breakup time was 18.4 seconds in the second group and 10 seconds in the fourth group (P < .02).

Mean tear breakup time 1 month after surgery was 18.4 seconds in the biaxial surgery group and 10.3 seconds in the coaxial group; the difference was statistically significant (P < .05). Incision length also correlated with tear breakup time.

Mean logMAR uncorrected visual acuity was 0.50 in the first group and 0.29 in the third group 1 day after surgery (P < .01). The between-group differences were insignificant at 1 week and 1 month.

Patient discomfort was significantly lower in the first group than the third group at 1 week and 1 month, Dr. Issa said.

“In many cases after phaco surgery, we notice persistent patient complaints of foreign body sensation, discomfort and intermittent blurred vision,” he said. “These complaints became significantly less in cases with punctal plugs, and our study proved that a statistically evident difference was present in cases with punctal plugs compared to control in both coaxial and biaxial phaco.” – by Matt Hasson

• Sameh Issa, MD, PhD, can be reached at the Department of Ophthalmology, Faculty of Medicine, Damascus University, Damascus, Syria; email: sameh-aissa@hotmail.com.
• Disclosure: Dr. Issa has no relevant financial disclosures.