ARTICLE | OPHTHALMOLOGY | When there is an indication for
permanent punctal occlusion, RF with the use of the CPO was more efficient and more cost-effective than any of the other modalities.
is still visible, the tip of the CPO is applied on the lumen to seal it. At the end of the procedure, an antibiotic ointment is applied and used for a few days. No patches are necessary following treatment. This is a safe, fast,
Figure 9 Postoperative result. Sealed lower punctum on the lower right lid
duct. The CPO is the cone-shaped Ellman RF electrode
TNAEE287, patented and approved by the US Food and Drug Administration (FDA). With the CPO, a very effective treatment modality has been added to the treatment methods that are available for dry eye syndrome.
Technique The eyelid is infiltrated with Xylocaine from the conjunctival side (Figure 5). The CPO ® mounted on the Ellman handpiece ® is inserted in the lumen of the canaliculus (Figures 6 and 7). The Surgitron is set on Ôcut/ coagÕ mode, the unit is activated for a few seconds (Figure 8), and then the CPO is pulled out. If the punctum
successful and cost-effective technique. One eye is treated at a time, addressing the lower punctum (Figures 9 and 10). If dry eye symptoms do not resolve, the upper punctum is occluded in the same manner. With the punctum completely sealed, the patient is relieved from the risk of irritation, inflammation, foreign body sensation, and light sensitivity for example.
Figure 10 Postoperative result. Sealed lower punctum on both sides
Discussion When there is an indication for permanent punctal occlusion, RF with the use of the CPO was more efficient and more cost-effective than any of the other modalities. The RF unit operates at a high frequency of 4.0 Mhz. The patented microprocessor circuit matches the wattage, waveform, alloy and patientÕs impedance to the optimum 4.0 Mhz. As the thicker diameter electrode produces slightly higher temperatures in tissue, the CPO has a thick cone-shaped design, eliminating the need to use a punctum dilator. The CPO is 5 mm long and is inserted nearly 4 mm into
the lumen. The punctum is sealed permanently. The authors have not experienced a reopening of the punctum or a lid notch as sometimes seen with cautery or lasers (Figures 11 and 12).
Conclusions In the experience of the authors, surgical punctal occlusion using the Argon laser has a very low success rate in comparison with the diode laser. Both lasers were not cost-effective and showed a lower success rate compared with the Ellman RF unit. When there is an indication for permanent punctal
occlusion, RF with the CPO has been more efficient and cost-effective than other treatment modalities that
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