Punctual plug and dry eye after photorefractive keratectomy Autors: Marcos Alonso Garcia, Daniela Akemi Miyamoto, Luiz Humberto Teixeira Bóro, Gustavo Victor, Clarissa Machado Odloak, Gustav Arno Auwaerter, Paloma Juni G.Campos . Cornea Sector – Department of Ofthalmology Ana Costa Hospital of Santos - HAC There is no financial interest by the author and coauthor’s in this poster issue

Punctual plug and dry eye after photorefractive keratectomy Treatment of Pseudophakic CME with a Single Intravitreal Triamcinolone Acetonide Injection Punctual plug and dry eye after photorefractive keratectomy Purpose To value the efficiency of the use of collagen plug at the tear point in patients who presented diagnosis of dry eye, at the PRK post-operative with mitomicin C.

Punctual plug and dry eye after photorefractive keratectomy Treatment of Pseudophakic CME with a Single Intravitreal Triamcinolone Acetonide Injection Punctual plug and dry eye after photorefractive keratectomy Method It is a prospective, randomized with control group study. Initially, we select 30 eyes (15 patients) that will be valued in the seventh day of post-operative. However, due to alterations at the reepithelialization, and loss of follow up, we value 14 eyes (7 patients), who presented symptoms of dry eye, Break Up Time (BUT) less than 5 seconds or basal secretion test <5mm at 5 minutes or Schirmer I test <10mm at 5 minutes at the twentieth day of PRK post-operative with Mitomicin C. The PRK was made with LADAR Vision 4000 and mitomicin C 0,02 % for 30 seconds. The values of corneal ablation varied between 40,6 and 79,8 micra. The patients does not presents ocular diseases or dry eye at the beginning of study. The eyes were randomized in two groups. Group 1: eyes that received plug in the tear inferior point (0.3mm diameter x 1.5mm length), Control group: counter side eyes of group 1, which not received the plug. In the post-operative all the eyes received the same treatment. For subjective evaluation, the patients answered a daily questionnaire for one week. The objective evaluation was made with BUT, basal secretion and Schirmer I tests. The patients were re-examined after seven days. .

Punctual plug and dry eye after photorefractive keratectomy Treatment of Pseudophakic CME with a Single Intravitreal Triamcinolone Acetonide Injection Punctual plug and dry eye after photorefractive keratectomy Results

Punctual plug and dry eye after photorefractive keratectomy Treatment of Pseudophakic CME with a Single Intravitreal Triamcinolone Acetonide Injection Punctual plug and dry eye after photorefractive keratectomy Results

Punctual plug and dry eye after photorefractive keratectomy Treatment of Pseudophakic CME with a Single Intravitreal Triamcinolone Acetonide Injection Punctual plug and dry eye after photorefractive keratectomy Results

Punctual plug and dry eye after photorefractive keratectomy Treatment of Pseudophakic CME with a Single Intravitreal Triamcinolone Acetonide Injection Punctual plug and dry eye after photorefractive keratectomy Results

Punctual plug and dry eye after photorefractive keratectomy Results All the Schirmer I tests were > 10mm at 5 minutes and basal secretion tests were > 5mm at 5 minutes. The objective evaluation showed few differences in the Break Up Time after seven days of the use of plug. This fact can be explained by the absorption of the plug, which would be efficient in the first days. At the subjective evaluation we saw that five of seven patients had improvements in some symptoms, in the eyes with plug. The Patient 1 had ardency symptom (middle intensity) before plug, improving for weak intensity at the first day of plug, whereas in the eye without plug improved at the third day. The patient 2 felt blurred vision in dry atmosphere with middle intensity, improving for weak intensity in the first day of plug, and in another eye it improved in the third day. ) At the beginning, the patient 4 felt ardency symptom (middle intensity, becoming weak in the second day of plug, and at the forth day in the other. This patient reported foreign body sensation that improved at the second day of plug and at the sixth day in the eye without plug. The patient 6 related blurred vision in dry atmosphere (middle intensity), improving for weak at the second day, whereas in the eye without plug this symptom remained until the fifth day. The patient 7 felt weak symptom of ardency that disappeared at the second day in the eye with plug and at the seventh day in the other eye. He also felt blurred vision in dry atmosphere that improved at the third day in eye with plug and at the sixth day in the other eye. The patients 3 and 5 did not report differences in the both eyes.

Punctual plug and dry eye after photorefractive keratectomy Conclusions In accordance with this study, we check that the use of collagen plug at PRK post-operative did not demonstrate great changes in the objective analysis of dry eye. However at the subjective evaluation we saw significant improvements at the initials days after its introduction. In the fact we need other studies, with more expressive number of patients, for better conclusions.