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Causes of Punctal Plug Loss in Sjögren's Syndrome

 Na Eun Kim  ;  Hyunmin Ahn  ;  Ikhyun Jun  ;  Tae-Im Kim  ;  Kyoung Yul Seo 
 YONSEI MEDICAL JOURNAL, Vol.64(8) : 505-510, 2023-08 
Journal Title
Issue Date
Hospitals ; Humans ; Punctal Plugs* ; Retrospective Studies ; Risk Factors ; Sjogren's Syndrome*
Aqueous-deficient dry eye ; Sjögren's syndrome ; punctal plug
Purpose: To evaluate the long-term maintenance rate and associated factors of silicone punctal plugs in patients with Sjögren’s syndrome (SS).

Materials and Methods: We retrospectively reviewed the medical records of 163 patients with SS who underwent silicone punctal plug insertion between December 2013 and July 2021 at Severance Hospital. The status of punctal plug insertions was classified into the following three categories by the clinician: maintenance, spontaneous loss, and intended removal. Cox proportional haz ards model was used to evaluate the risk factors for spontaneous loss.

Results: The mean 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 prior plug insertions was a risk factor for spontaneous loss [hazard ratio (HR) 1.055, p=0.035]. The upper eyelid punctum was at a higher risk than the lower one (p=0.042). Small-sized plugs showed a significantly higher risk for spontaneous loss than large-sized ones (HR 1.287, p=0.035). Flow-controller type plugs were more vul nerable to spontaneous loss than complete occluders [Micro FlowTM vs. EagleFlex® (HR 2.707, p=0.008) and Micro FlowTM vs. Ul traplugTM (HR 3.402, p=0.005)]. The most common reason for removal was tear overflow (5.6%).

Conclusion: In 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, re quires personalized strategies for versatile situations.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Ophthalmology (안과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Tae-Im(김태임) ORCID logo https://orcid.org/0000-0001-6414-3842
Seo, Kyoung Yul(서경률) ORCID logo https://orcid.org/0000-0002-9855-1980
Ahn, Hyunmin(안현민)
Jun, Ik Hyun(전익현) ORCID logo https://orcid.org/0000-0002-2160-1679
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