Rectangular 3-snip Punctoplasty Outcomes: Preservation of the Lacrimal Pump in Punctoplasty Surgery

Abstract

To report a method of rectangular 3-snip punctoplasty (2 vertical cuts at either side of the vertical canaliculus and 1 cut at the base). Outcomes are compared with the more conventional and anatomically destructive 3-snip triangular punctoplasty (1 cut at the vertical canaliculus, 1 cut at the horizontal canaliculus, and 1 cut at the base). Retrospective review of all eyes undergoing 3-snip punctoplasty between January 1, 2003 and January 8, 2005. Seventy-five patients were eligible for this study. One hundred eight eyes with patent punctum and lacrimal systems prior to surgery underwent punctoplasty (49 rectangular and 59 triangular punctoplasty). Follow-up of 8 days to 2.3 years (mean, 0.68 years). Ages ranged between 16.8 and 99.8 years (mean, 69.5 years). Forty-five patients (60%) were women. There was a trend for patients to be symptomatic postoperatively despite patent punctum and lacrimal systems following triangular (10 of 59, 16.9%) than those who underwent rectangular punctoplasty (5 of 49, 10.2%) although this difference was not significant (difference in proportions = 0.05; CI: -17.635 to 17.645; p = 0.99). This study showed that there were more failures in eyes with triangular punctoplasty. Previous studies have shown that the punctae and canaliculi are important in normal lacrimal drainage. Rectangular punctoplasty is a simple, safe, and quick procedure that maintains the normal anatomy and physiology of the canalicular system, while maintaining a patent punctum and should be considered as a less destructive alternative to the traditional triangular punctoplasty.