ISSN: 2706-8870
Volume 6, Number 6 (2021)
Year Launched: 2016

Evaluation of efficacy of plasma assisted noninvasive surgery (PANIS) as a novel approach for temporary punctal occlusion: a clinical case series

Volume 6, Issue 6, December 2021     |     PP. 421-432      |     PDF (222 K)    |     Pub. Date: October 7, 2021
DOI: 10.54647/cm32620    82 Downloads     5117 Views  

Author(s)

Farhad Nejat, Vision health research center, Tehran, Iran
Khosrow Jadidi, Vision health research center, Tehran, Iran
Shima Eghtedari, Vision health research center, Tehran, Iran
Nazanin-Sadat Nabavi, Vision health research center, Tehran, Iran

Abstract
Background: Several studies have reported plasma-assisted noninvasive surgery (PANIS method) as a simple, inexpensive, office-based, minimally invasive, effective technique for treating some ocular surface diseases. This study aims to explore the efficacy of this method for occluding tear drainage system, temporary, in order to treat dry eye disease.
Methods: Study was undertaken in six patients with moderate to severe dry eye (Schirmer’s test < 10 mm and TBUT 10 sec). The inferior puncta were fused using white handpiece of the plasma generator device (Plexr, GMV s.r.l Grottaferrata, Italy) under topical anesthesia and they remained occlude for 2-5 days. The efficacy of the PANIS method was assessed with comprising Refraction, visual acuity, intraocular pressure (IOP), corneal fluorescein staining score (CFS), contrast sensitivity (CS), Schirmer test values, dry eye tests, and ocular surface disease index (OSDI) questionnaire which were collected before, 1week, 1month and 6 months after the procedure and during the first week after this treatment, the slit-lamp examination was performed every day.
Results: All patients showed a significant decrease in corneal fluorescein staining score (CFS) and OSDI questionnaire. In the first three days after procedure, tear meniscus height and tear beak-up time had remarkably improved. Moreover, daily slit-lamp examinations during the first week showed that puncta remained occlude for 2-5 days. In addition, refraction, visual acuity and intraocular pressure showed no considerable change during the 6-month follow-up.
Conclusion: According to the findings, the PANIS method seems to be a temporary effective approach for treating dry eye disease (DED). Since no Signs and symptoms of DED were observed within the first week, this novel technique was concluded to be able of evaluating pre-permanent punctual occlusion and also first week after procedure would make a good time for repairing damaged ocular surface with any particular reasons.

Keywords
Temporary punctal occlusion; Plasma; Dry eye disease; Ocular surface disease

Cite this paper
Farhad Nejat, Khosrow Jadidi, Shima Eghtedari, Nazanin-Sadat Nabavi, Evaluation of efficacy of plasma assisted noninvasive surgery (PANIS) as a novel approach for temporary punctal occlusion: a clinical case series , SCIREA Journal of Clinical Medicine. Volume 6, Issue 6, December 2021 | PP. 421-432. 10.54647/cm32620

References

[ 1 ] Ervin, A.M., A. Law, and A.D. Pucker, Punctal occlusion for dry eye syndrome. Cochrane Database of Systematic Reviews, 2017(6).
[ 2 ] Wang, Y., et al., Long-term Outcomes of Punctal Cauterization in the Management of Ocular Surface Diseases. Cornea, 2021. 40(2): p. 168-171.
[ 3 ] Dohlman, C.H., Punctal occlusion in keratoconjunctivitis sicca. Ophthalmology, 1978. 85(12): p. 1277-1281.
[ 4 ] Arita, R., S. Fukuoka, and N. Morishige, Functional morphology of the lipid layer of the tear film. Cornea, 2017. 36: p. S60-S66.
[ 5 ] De Roetth, A., Lacrimation in normal eyes. AMA archives of ophthalmology, 1953. 49(2): p. 185-189.
[ 6 ] Perry, H.D. and E.D. Donnenfeld, Dry eye diagnosis and management in 2004. Current opinion in ophthalmology, 2004. 15(4): p. 299-304.
[ 7 ] Schirmer, O., Studien zur physiologie und pathologie der tränenabsonderung und tränenabfuhr. Albrecht von Graefes Archiv für Ophthalmologie, 1903. 56(2): p. 197-291.
[ 8 ] Lemp, M.A. and G.N. Foulks, The definition and classification of dry eye disease. Ocul Surf, 2007. 5(2): p. 75-92.
[ 9 ] Terry, M.A., Dry eye in the elderly. Drugs & aging, 2001. 18(2): p. 101-107.
[ 10 ] Messmer, E.M., The pathophysiology, diagnosis, and treatment of dry eye disease. Deutsches Ärzteblatt International, 2015. 112(5): p. 71.
[ 11 ] Gayton, J.L., Etiology, prevalence, and treatment of dry eye disease. Clinical ophthalmology (Auckland, NZ), 2009. 3: p. 405.
[ 12 ] Pflugfelder, S.C., Prevalence, burden, and pharmacoeconomics of dry eye disease. Am J Manag Care, 2008. 14(3 Suppl): p. S102-S106.
[ 13 ] Yamada, M., Review 38. Dry eye syndrome: concept, pathogenesis, and therapeutic modalities based on the new definition. Nippon Ganka Gakkai zasshi, 2009. 113(4): p. 541-552.
[ 14 ] de Paiva, C.S., Effects of aging in dry eye. International ophthalmology clinics, 2017. 57(2): p. 47.
[ 15 ] Korb, D.R., et al., Effect of periocular humidity on the tear film lipid layer. Cornea, 1996. 15(2): p. 129-134.
[ 16 ] Hikichi, T., et al., Prevalence of dry eye in Japanese eye centers. Graefe's archive for clinical and experimental ophthalmology, 1995. 233(9): p. 555-558.
[ 17 ] Rosenfield, M., Computer vision syndrome: a review of ocular causes and potential treatments. Ophthalmic and Physiological Optics, 2011. 31(5): p. 502-515.
[ 18 ] Uchino, M., et al., Prevalence of dry eye disease among Japanese visual display terminal users. Ophthalmology, 2008. 115(11): p. 1982-1988.
[ 19 ] Dohlman, T.H., E.C. Lai, and J.B. Ciralsky, Dry eye disease after refractive surgery. International ophthalmology clinics, 2016. 56(2): p. 101-110.
[ 20 ] Price, E.J., et al., The British Society for Rheumatology guideline for the management of adults with primary Sjogren's Syndrome (vol 56, pg 1643, 2017). Rheumatology, 2017.
[ 21 ] Zeev, M.S.-B., D.D. Miller, and R. Latkany, Diagnosis of dry eye disease and emerging technologies. Clinical Ophthalmology (Auckland, NZ), 2014. 8: p. 581.
[ 22 ] Kaštelan, S., et al., Diagnostic procedures and management of dry eye. BioMed research international, 2013. 2013.
[ 23 ] Rosen, N., I. Ashkenazi, and M. Rosner, Patient dissatisfaction after functionally successful conjunctivodacryocystorhinostomy with Jones tube. American journal of ophthalmology, 1994. 117(5): p. 636-642.
[ 24 ] Tiffany, J.M., The viscosity of human tears. International ophthalmology, 1991. 15(6): p. 371-376.
[ 25 ] Albert, D.M., Principles and practice of ophthalmology: Basic sciences. 1994: Saunders.
[ 26 ] Schultz, C., Safety and efficacy of cyclosporine in the treatment of chronic dry eye. Ophthalmology and eye diseases, 2014. 6: p. OED. S16067.
[ 27 ] Wilson, S.E. and H.D. Perry, Long-term resolution of chronic dry eye symptoms and signs after topical cyclosporine treatment. Ophthalmology, 2007. 114(1): p. 76-79.
[ 28 ] Javadi, M.-A. and S. Feizi, Dry eye syndrome. Journal of ophthalmic & vision research, 2011. 6(3): p. 192.
[ 29 ] Tsubota, K., et al., Treatment of persistent corneal epithelial defect by autologous serum application. Ophthalmology, 1999. 106(10): p. 1984-1989.
[ 30 ] Fridman, G., et al., Applied plasma medicine. Plasma processes and polymers, 2008. 5(6): p. 503-533.
[ 31 ] Heslin, C., et al., Quantitative assessment of blood coagulation by cold atmospheric plasma. Plasma Medicine, 2014. 4(1-4).
[ 32 ] Heinlin, J., et al., Plasma applications in medicine with a special focus on dermatology. Journal of the European Academy of Dermatology and Venereology, 2011. 25(1): p. 1-11.
[ 33 ] Graves, D.B., The emerging role of reactive oxygen and nitrogen species in redox biology and some implications for plasma applications to medicine and biology. Journal of Physics D: Applied Physics, 2012. 45(26): p. 263001.
[ 34 ] Weltmann, K.-D., H.-R. Metelmann, and T. Von Woedtke, Low temperature plasma applications in medicine. Europhysics News, 2016. 47(5-6): p. 39-42.
[ 35 ] Laroussi, M., Plasma medicine: a brief introduction. Plasma, 2018. 1(1): p. 47-60.
[ 36 ] Nejat, F., et al., A Novel Approach to Treatment of Conjunctival Cyst Ablation Using Atmospheric Low-Temperature Plasma. Clinical Ophthalmology (Auckland, NZ), 2020. 14: p. 2525.
[ 37 ] Jadidi, K., et al., Evaluation of plasma assisted noninvasive surgery (PANIS) as a new approach for the treatment of conjunctivochalasis; a clinical case series. Expert Review of Ophthalmology, 2021: p. 1-6.
[ 38 ] Nejat, F., et al., Safety evaluation of the plasma on ocular surface tissue: an animal study and histopathological findings. Clinical Plasma Medicine, 2019. 14: p. 100084.
[ 39 ] Alfawaz, A.M., et al., Efficacy of punctal occlusion in management of dry eyes after laser in situ keratomileusis for myopia. Current eye research, 2014. 39(3): p. 257-262.
[ 40 ] Patten, J.T., Punctal occlusion with n-butyl cyanoacrylate tissue adhesive. 1976, SLACK Incorporated Thorofare, NJ.
[ 41 ] Farrell, J., et al., A clinical procedure to predict the value of temporary occlusion therapy in keratoconjunctivitis sicca. Ophthalmic and Physiological Optics, 2003. 23(1): p. 1-8.
[ 42 ] Glatt, H.J., Failure of collagen plugs to predict epiphora after permanent punctal occlusion. 1992, SLACK Incorporated Thorofare, NJ.
[ 43 ] Baxter, S.A. and P.R. Laibson, Punctal plugs in the management of dry eyes. The ocular surface, 2004. 2(4): p. 255-265.
[ 44 ] Knapp, M.E., et al., A comparison of two methods of punctal occlusion. American journal of ophthalmology, 1989. 108(3): p. 315-318.
[ 45 ] Koh, C.H. and T.Y. La, Treatment of punctal occlusion using pigtail probe. Ophthalmic Plastic & Reconstructive Surgery, 2013. 29(2): p. 139-142.
[ 46 ] Emmert, S., et al., Atmospheric pressure plasma in dermatology: Ulcus treatment and much more. Clinical Plasma Medicine, 2013. 1(1): p. 24-29.
[ 47 ] Sotiris, T.G., G. Nikolaos, and G. Irini, New treatment with plasma exeresis for non-surgical blepharoplasty. EC Ophthalmology, 2017. 5(4): p. 156-159.