Maintenance Associated Factors Of Punctal Plug In Sjögren's Syndrome

Published 2023 - 41st Congress of the ESCRS

Reference: PO0776 | DOI: 10.82333/vj0v-ca06

Authors: Na Eun Kim* ¹ , Hyunmin Ahn ¹ , Ikhyun Jun ¹ , Tae-im Kim ¹ , Kyoung Yul Seo ¹

¹Department of Ophthalmology,Institute of Vision Research, Yonsei University College of Medicine,Seoul,Korea, Republic Of

To evaluate the long-term maintenance rate and associated factors of silicone punctal plugs in patients with Sjögren’s syndrome.

This is a retrospective, consecutive, and observational case series study. This study included all patients with primary Sjögren’s syndrome who underwent silicone punctal plug insertion between December 2013 and July 2021 at the Severance Hospital. Patients who did not show improvement in the ocular surface condition or dry eye-related symptoms after topical eye drop treatment, including artifical tear drop, were included in the study.

We retrospectively reviewed the medical records of 163 patients with Sjögren’s syndrome who underwent silicone punctal plug insertion between December 2013 and July 2021 at the Severance Hospital. The status of the punctal plug insertion was classified into three categories by the clinician: maintenance, spontaneous loss, and intended removal. The timing and occurrence of spontaneous loss or intended removal of punctal plug were recorded. The Cox proportional hazards model was used to evaluate the risk factors for spontaneous loss.

A mean value of the maintenance period was 12.8±15.3 (median 7.07) months. The rate of spontaneous loss was 58% and the rate of punctal plug removal by the clinician was 14%. The number of repeated insertions was a risk factor for spontaneous loss (hazard ratio [HR] 1.055, p value = 0.035). The upper eyelid punctum was at a higher risk than the lower one (p = 0.042). Larger plugs had a higher maintenance rate than smaller-sized plugs (HR 1.287, p = 0.041). Perforated punctal plug (partial occluder) was more vulnerable to spontaneous loss than complete occluders ([HR 2.707, p = 0.008] and [HR 3.402, p = 0.005]). The most common reason for removal was tear overflow (5.6%).

Repeated insertion, characteristics of the punctal plug, including the type and size, and location of plug insertion influenced the spontaneous loss of plugs. The management of punctal plugs, including insertion, maintenance, and removal, requires personalized strategies for versatile situations.