Evaluation Of Plasma-Assisted Noninvasive Surgery (Panis) Effect On Punctal Occlusion After Multiple Consecutive Treatments; A Clinical Case Series

The current study aims to evaluate plasma-assisted noninvasive surgery (PANIS) as a novel technique for punctal occlusion to attain a long-term stricture of the punctum.

This study set as a case series in Vision health research center, Tehran, Iran.

This study involved 10 eyes from 10 female patients with grade 3 and 4 severity of dry eye disease (DED) based on the Delphi Panel scheme of dry eye. The punctal occlusion was conducted using the fusion mechanism of plasma spots using the white handpiece of the Plexr device (GMV, Italy). One single surgeon implemented the procedure three times at 2 weeks intervals. This office-based technique was assessed with acuity parameters, dry eye tests, and patient satisfaction evaluated by OSDI questionnaire before, and one month and six months after the procedure.

A remarkable improvement was observed in tear meniscus height (TMH) and tear break-up time (TBUT) in quite all patients. The visual parameters and intraocular pressure (IOP) had not considerably changed, but CFS decreased due to more tear stability in the 6 months. The OSDI questionnaire scores of all patients had reduced after the procedure. After all sessions, patients reached a quite long-term stricture in their puncta, whereas no complications or side effects were reported after a 6-month follow-up. 

Findings of this clinical case serial study led to a novel therapy method for DED that results in the punctum stricture for months, using the PANIS method as an effective, safe, office-based, easy, and inexpensive approach where recalcitrance to the medical therapy occurs.