Lid Margin And Conjunctival Microbial Flora Following Punctum Occlusion

This study has been completed.
Sponsor:
Information provided by:
Lahey Clinic
ClinicalTrials.gov Identifier:
NCT00735865
First received: August 13, 2008
Last updated: May 22, 2009
Last verified: May 2009
  Purpose

To determine if the types and amount of bacteria or other germs change over time after the routine procedure of blockage of tear drainage duct in the treatment of dry eye condition or other condition benefiting from a tear drainage blockage


Condition Intervention
Dry Eye Syndrome
Procedure: Punctal plugs, punctal cautery
Procedure: Punctal Plug, Punctal thermocauterization
Procedure: Silicone plug or thermodynamic hydrophobic acrylic plug
Other: Previous subjects with Punctal occlusion

Study Type: Interventional
Study Design: Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Lid Margin And Conjunctival Microbial Flora Following Punctum Occlusion

Resource links provided by NLM:


Further study details as provided by Lahey Clinic:

Primary Outcome Measures:
  • Impact of punctal occlusion on the ocular microbial flora [ Time Frame: 1 year(3mo, 6mo, 12 mo culture/follow up visits) ] [ Designated as safety issue: No ]

Enrollment: 55
Study Start Date: July 2003
Study Completion Date: May 2009
Primary Completion Date: April 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: 1 Procedure: Punctal plugs, punctal cautery
25 subjects(20 silicone punctal plugs, 5 punctal cautery) The procedure will be based on clinical indication. Randomized one eye for study. Baseline cultures of lid margin & tarsal/inferior fornix conjunctiva obtained & plated according to protocol
Active Comparator: 2 Procedure: Punctal Plug, Punctal thermocauterization

Up to 5 subjects. Subjects in need of punctal occlusion(No preference for punctal thermocauterization or punctal occlusion by silicone plug). Randomize one eye to silicone punctal plug occlusion, the other eye to punctal thermocauterization.

This group ONLY, cultures will be obtained of the lid margin & conjunctiva/inferior fornix of BOTH eyes

Active Comparator: 3 Procedure: Silicone plug or thermodynamic hydrophobic acrylic plug

Up to 5 subjects. Subjects in need of punctal occlusion(not preference for punctal occlusion by silicone plug or by the thermodynamic hydrophobic acrylic plug). Randomize one eye to silicone punctal plug occlusion, the other eye to acrylic punctal plug occlusion.

In this group ONLY cultures will be obtained of the lid margin and conjunctiva/inferior fornix of BOTH eyes

Active Comparator: 4 Other: Previous subjects with Punctal occlusion

Up to 20 subjects(15 subjects with silicone punctal plug closure and 5 subjects with punctal closure by thermocauterization)Subjects who have previously had punctal occlusion who have symptoms and/or signs thought to be secondary to punctal occlusion.

Lid margin and conjunctiva/inferior fornix of eye with greatest sign or symptoms will be cultured/plated according to standard protocol.


Detailed Description:

This study will investigate the impact of punctal occlusion on the ocular microbial flora. Current thought is that punctal occlusion causes retention of inflammatory mediators on the ocular surface which may produce pathology, we hypothesize that blockage of the nasolacrimal drainage system may allow colonization of the ocular surface by potentially pathogenic ubiquitous organisms (which may produce exotoxins and other biologic products) that may be responsible for signs and symptoms seen in some patients. Additionally, the presence of the silicone foreign body(punctal plug) may act as a nidus for bacterial adhesion with biofilm production (which is known to occur with Pseudomonas sp and other organisms). There would thus be a paradigm shift of our current understanding of the pathophysiology of punctal occlusion. Additionally, the choice of antimicrobials for the treatment of infections in patients with punctal occlusion may need to be modified if the microbial flora is found to be different in patients with punctal occlusion.

The ocular flora may be different inpatients with severe dry eye or other chronic pathologic conditions, which are frequent indications for punctal occlusion. However, from our retrospective review, we could not determine if there was a change in the microbial flora following plug placement with colonization with these "unusual organisms" since baseline cultures prior to punctal plug placement were not obtained.

We will try to differentiate any effect on the microbial flora caused by the silicone plug or acrylic plug(as a foreign body) versus the punctal closure by thermocautery. (Punctal thermocauterization is an alternative method of punctal closure which is 1) the preferred choice by some ophthalmologists for all their cases, or 2) when the dry eye is severe and irreversible punctal occlusion is desired or 3) if punctal plugs can not be retained due to the large size of the patients punctal). The thermodynamic hydrophobic acrylic plug(SmartPLUG) approved by the FDA for punctal occlusion with the same indications as the traditional silicone plug.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • 18 years and older
  • Able to sign Informed Consent
  • Clinical indication for punctal plug insertion or punctal cautery or symptomatic patients who have previously had punctal occlusion
  • Clinical indication for punctal plug removal(Partial extrusion, discomfort) increased signs of ocular irritation with punctate keratopathy, punctal inflammation).
  • Able to make follow up visit schedule

Exclusion Criteria:

  • Subjects without dry eye
  Contacts and Locations
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Please refer to this study by its ClinicalTrials.gov identifier: NCT00735865

Locations
United States, Massachusetts
Lahey Clinic, Inc.
Burlington, Massachusetts, United States, 01805
Lahey Clinic North
Peabody, Massachusetts, United States, 01960
Sponsors and Collaborators
Lahey Clinic
Investigators
Principal Investigator: Sarkis H. Soukiasian, M.D. Lahey Clinic, Inc.
  More Information

No publications provided

Responsible Party: Sarkis H. Soukiasian, M.D., Lahey Clinic, Inc.
ClinicalTrials.gov Identifier: NCT00735865     History of Changes
Other Study ID Numbers: 2003-049
Study First Received: August 13, 2008
Last Updated: May 22, 2009
Health Authority: United States: Institutional Review Board

Keywords provided by Lahey Clinic:
Dry Eye Syndrome
Punctal Occlusion
Punctal Plugs
Tear Drainage duct blockage

Additional relevant MeSH terms:
Dry Eye Syndromes
Keratoconjunctivitis Sicca
Syndrome
Lacrimal Apparatus Diseases
Eye Diseases
Keratoconjunctivitis
Conjunctivitis
Conjunctival Diseases
Keratitis
Corneal Diseases
Disease
Pathologic Processes

ClinicalTrials.gov processed this record on October 19, 2014