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Factors affecting outcome of punctoplasty surgery: a review of 205 cases
  1. Humma Shahid (hummashahid{at}hotmail.com),
  2. Amanjeet Sandhu (amanjeetsandhu{at}hotmail.com),
  3. Tiarnan Keenan (tiarnan.keenan{at}doctors.org.uk),
  4. Andrew Pearson (andrew.pearson{at}royalberkshire.nhs.uk)
  1. Oxford Eye Hospital, United Kingdom
  2. Oxford Eye Hospital, United Kingdom
  3. Oxford Eye Hospital, United Kingdom
  4. Royal Berkshire Hospital, United Kingdom

    Abstract

    Aims: We have retrospectively reviewed the indications, surgical techniques and outcomes of punctoplasty surgery for 205 consecutive cases in order to identify factors that influence success.

    Methods: We identified all patients who underwent punctoplasty surgery during the period April 2002 to June 2006 within the Royal Berkshire NHS Trust. No patient had an additional procedure simultaneously. Hospital records were used to ascertain the proportion of patients who were appropriately assessed pre-operatively, the anatomical and functional success rates for surgery and the patient satisfaction rate. We assessed the influence of surgical technique, grade of operating surgeon and the use of post-operative topical medication on these outcomes.

    Results: 82% of patients had an appropriate pre-operative assessment. Amongst these, the anatomical and functional success rates for punctoplasty surgery were 91% and 64% respectively. The patient satisfaction rate was 71%. The grade of surgeon did not significantly affect outcome of punctoplasty (P=0.4). The use of topical steroids post-operatively did not significantly improve surgical outcome (P=0.7). There was no significant difference in anatomical success between a 2-snip versus a 3-snip punctoplasty technique (P=0.7). However, in the presence of anatomical success the 2-snip procedure gave significantly greater functional success (P=0.03).

    Conclusions: This is the largest reported consecutive case series of isolated punctoplasty surgery. Overall anatomical success is high and the surgical technique, grade of surgeon and choice of post-operative medication do not significantly alter the outcome. Without adequate pre-operative assessment a significant proportion of patients may undergo surgery inappropriately. Even with an adequate assessment anatomical success is not always followed by resolution of epiphora.

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