[Treatment progress of large-size puncta and clinical investigation of the extrusion rate and other complications associated with large-size punctal plugs].

PURPOSE: One complication of punctal plug occlusion (PPO) is enlargement of the punctum. The purpose of the present study was to investigate large-size (over 1.0 mm) puncta after punctal plug extrusion. SUBJECTS AND METHODS: This study involved the treatment progress of 74 large-size (over 1.0 mm) puncta in 55 eyes of 46 patients who underwent PPO. The extrusion rate and other complications of the total 133 punctal plugs used for those puncta were investigated. RESULTS: Of the 74 puncta, 33 (44%) achieved occlusion by PPO alone, 20 (27%) achieved perfect occlusion of granulation, and 21 (29%) required surgical punctal occlusion. Although larger or longer punctal plug sizes have been used for PPO, the average elapsed time until extrusion was 143.5 +/- 217.0 (mean +/- SD) days, and the time until 50% of the plugs were extruded was 50 days. No significant extrusion rate was found among the punctal plugs, and there was 0% migration rate. Granulation was observed in 20.3% of the plugs, yet no soft whitish material was seen around the plugs. CONCLUSION: The findings of this study show that large-size puncta can successfully be occluded for a fixed period of time following PPO.