• Clin. Experiment. Ophthalmol. · Nov 2018

    Randomized Controlled Trial

    Effect of a punctal plug on ocular surface disease in patients using topical prostaglandin analogues: a randomized controlled trial.

    • Justin C Sherwin, Gokulan Ratnarajan, Babar Elahi, Anna Bilkiewicz-Pawelec, and John F Salmon.
    • Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK.
    • Clin. Experiment. Ophthalmol. 2018 Nov 1; 46 (8): 888-894.

    ImportanceOcular surface disease (OSD) is common and can reduce treatment compliance and quality of life.BackgroundTo determine whether a punctal plug improves OSD and reduces intraocular pressure (IOP) in patients using prostaglandin analogue monotherapy.DesignRandomized controlled trial.ParticipantsSixty eligible subjects aged >18 years with symptomatic OSD from glaucoma clinics were invited to participate. Lacrimal or glaucoma surgery, lid malposition and contact lens wear were exclusion criteria.MethodsOne eye received an inferior punctal plug, leaving the fellow eye as a control.Main Outcome MeasuresOcular surface disease index (OSDI), tear film breakup time (TF-BUT), Oxford cornea score, tear osmolarity and IOP were compared at baseline and 6 weeks by masked investigators.ResultsFrom 60 eligible, 48 (80.0%) participated (mean age 69.6 years; 60.0% female). OSDI reduced following plug insertion (mean difference [MD] 14.5, 95% confidence interval [CI] 5.06-23.94, P < 0.001). Compared to control eyes, in eyes receiving plugs the TF-BUT increased (MD 2.3 s, 95% CI 1.4-3.2, P < 0.001), the Oxford cornea score decreased (MD 0.5, 95% CI 0.3-0.7, P < 0.001), and tear osmolarity decreased (MD 10 mOsm/L, 95% CI 3.5-16.5, P = 0.003). Punctal plugs resulted in a significantly lowered IOP (MD 1.5 mmHg, 95% CI 0.1-2.9, P = 0.032). Sub-group analyses showed similar efficacy regardless of prostaglandin preservative status or lubricant drop use. Plugs were well tolerated but extrusion occurred in 8.5%, and epiphora increased in 6.5% eyes.Conclusions And RelevancePunctal plug insertion improves subjective and objective measures of OSD and results in a reduced IOP in patients with symptomatic ocular surface disease using prostaglandin analogue monotherapy.© 2018 Royal Australian and New Zealand College of Ophthalmologists.

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