• Na Eun Kim, Hyunmin Ahn, Ikhyun Jun, Tae-Im Kim, and Kyoung Yul Seo.
• The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
• Yonsei Med. J. 2023 Aug 1; 64 (8): 505510505-510.

PurposeTo evaluate the long-term maintenance rate and associated factors of silicone punctal plugs in patients with Sjögren's syndrome (SS).Materials And MethodsWe retrospectively reviewed the medical records of 163 patients with SS who underwent silicone punctal plug insertion between December 2013 and July 2021 at Severance Hospital. The status of punctal plug insertions was classified into the following three categories by the clinician: maintenance, spontaneous loss, and intended removal. Cox proportional hazards model was used to evaluate the risk factors for spontaneous loss.ResultsThe mean maintenance period was 12.8±15.3 (median 7.07) months. The rate of spontaneous loss was 58%, and the rate of punctal plug removal by the clinician was 14%. The number of prior plug insertions was a risk factor for spontaneous loss [hazard ratio (HR) 1.055, p=0.035]. The upper eyelid punctum was at a higher risk than the lower one (p=0.042). Small-sized plugs showed a significantly higher risk for spontaneous loss than large-sized ones (HR 1.287, p=0.035). Flow-controller type plugs were more vulnerable to spontaneous loss than complete occluders [Micro Flow™ vs. EagleFlex® (HR 2.707, p=0.008) and Micro Flow™ vs. Ultraplug™ (HR 3.402, p=0.005)]. The most common reason for removal was tear overflow (5.6%).ConclusionIn repeated insertion, characteristics of the punctal plug, including the type and size, and location of plug insertion, influenced the spontaneous loss of plugs. The management of punctal plugs, including insertion, maintenance, and removal, requires personalized strategies for versatile situations.© Copyright: Yonsei University College of Medicine 2023.

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