[The short-term efficacy and psycological influence of elastic silicon punctal plugs on severe dry eye patients].

Objective: To evaluate the short-term efficacy and psycological influence of elastic silicon punctal plugs on severe dry eye patients. Methods: Prospective case series study. Twenty-eight severe dry eye patients (56 eyes) treated with elastic silicon punctal plugs (Snug Plugs(TM), FCI Ophthalmics, France) during January to September 2017 at the ophthalmology department of Peking Union Medical College Hospital were included. All the examination results were collected at baseline and 3 months after insertion. Uncorrected visual acuity (UCVA), silt lamp examination, conjunctiva grading (CG), lower tear meniscus height (TMS), tear break-up time (BUT), Schirmer Ⅰ test (SⅠt, without anesthesia), corneal fluoresce staining (FS) were recorded to evaluate the efficacy of the plugs. Meanwhile, Ocular Surface Disease Index (OSDI), Self-Rating Anxiety Scale (SAS) and Center for Epidemiological Survey-Depression Scale (CES-D) were collected to assess the changes of patients' symptoms and psychological status. Results: At baseline and 3 months after punctal plugs insertion, mean OSDI score was 65.77±21.28 and 42.85±20.08; mean UCVA was 0.10 (0.30) and 0.06 (0.27), mean TMS was (0.17±0.09) and (0.35±0.17) mm;mean CG score was 2.96±1.13 and 1.57±0.99; mean BUT was (3.23±2.62) and (5.09±3.36) s;mean FS score was 7.32±4.46 and 5.15±4.02; mesn SⅠt was (4.09±3.48) and (8.15±5.96) mm; mean SAS score was 46.70±9.73 and 40.59±8.98, respectively. All the above differences between results of baseline and 3 months after insertion were of statistical significance (t=6.11, -6.31, 8.91, -8.97, -3.83, 5.06, -6.14, 3.04, P<0.01). The mean CES-D score at baseline was 21.25±10.82, which was statistically different from the result of 15.00±10.53 at 3 months after insertion (t=2.38, P<0.05). The number and the severity of patients with anxiety or depression were reduced after insertion. OSDI score was negatively correlated with UCVA, TMH and SⅠt (r=-0.42, -0.61, -0.31, P<0.05), and was positively correlated with FS, SAS and CES-D score (r=0.36, 0.31, 0.28, P<0.05). The main complication identified during this study was spontaneous loss of the punctal plugs (3 eyes, 8.82%). Conclusions: Short term elastic silicon punctal plugs are effective for treating moderate to severe dry eye, and such treatment can partly alleviate the anxiety and depression of the patients. Still, more attentions to the psychological status of dry eye patients should be paid. (Chin J Ophthalmol, 2018, 54: 437-444).