Cautery - better option?

[Danny_]

Danny,
Which of the three statements did she say wasn't the case?

That cautery damages tissue. You are burning the tissue with cauterization.

That once it is burned together you can reverse it without surgery.

Cauterization reopens in 50% of the cases.

The last one (er...don't know how that couldn't have been clear to you given that I quoted it). What's your source for that claim you made? Can we evaluate it ourselves?

[Rebecca Petris]

The last one (er...don't know how that couldn't have been clear to you given that I quoted it). What's your source for that claim you made? Can we evaluate it ourselves?

Er... don't know how it couldn't have been confusing to him given that you quoted all three.

IndRep I'd be interested in any particular references for the re-opening rate myself - never looked into it but as high as 50% surprises me. I tried Medline and on the first page of hits the only one that mentioned re-opening rates in the abstract said 20% but possibly possibly the rates are in the body of some of the other studies and not the abstract.

[Danny_]

Er... don't know how it couldn't have been confusing to him given that you quoted all three.

I was clearly referring to the previous post where I quoted the 50% statistic. If you scroll up the thread, you would see what I am referring to.

[Rebecca Petris]

Danny:

PLEASE READ YOUR OWN BLOODY POST AGAIN. IT'S NUMBER 12.

[indrep]

Rebecca,
It has been some time, about 8-9 years ago, since I had that study in hand. Unfortunately it was paper and not on the web. If I can find it I will put the particulars on the board. Several ofice cleanings have happened since then so I am not making any promises.

The rate quoted include those done by laser as well as cautery so that might explain some difference in rates. It also made reference to "as high as 50%". In my notes this is what I wrote:Cautery/laser up to 50% reopen rate.

[Danny_]

My apologies Rebecca. You are right. It's hard for me to look at the computer right now given that my eye is hurting (can't do it for more than 5 mins). I suppose that I felt it was so obvious that I was referring to the 50 percent stat as I am hardly going to ask the doctor about any of the other two things that I thought his reply was dodging the question.

[Danny_]

Rebecca,
It has been some time, about 8-9 years ago, since I had that study in hand. Unfortunately it was paper and not on the web. If I can find it I will put the particulars on the board. Several ofice cleanings have happened since then so I am not making any promises.

The rate quoted include those done by laser as well as cautery so that might explain some difference in rates. It also made reference to "as high as 50%". In my notes this is what I wrote:Cautery/laser up to 50% reopen rate.

What does "the rate quoted includes those done by laser as well as cautery" mean? You made no reference to laser in your original quote which was:

"The down side to cautery is damages tissue that cannot be reversed without surgery. Also it opens back up in up to 50% of patients. Once cauterized you can not use the silicone plugs.

Just some things to think about."

[kitty]

More about the risks of cautery...

I have yet to find any study quoting a 50% failure rate for cautery in general. Failure rates for laser cautery are much higher than those for thermal. While searching, I did come up with some other interesting tidbits!

Study 1 British Journal of Ophthalmology


Failure of cautery appears to be dependent on how the procedure was performed...
Am. Journal Ophthalmology

Laser punctal occlusion

Read this and you won't be able to say, "Had I known the risks, I would not have done it"...
And in case you thought infection only happens with intracanalicular plugs....

Pictures of the cautery procedure, and others....

[indrep]

Kitty thanks for the links. I have looked into some old presentations I had to locate the source of my statements. It seems the 50% number was in a "White Paper" that was never published. It mostly consisted of a retrospective of patients in 8 clinics. But certainly the laser closure is not as reliable as the deep closure.

[Flick]

This article is from osnsupersite.com. I can't link it directly and I'm not sure if I'm allowed to post the entire text. But here are some important excerpts. (PS - is anyone else amazed that modern medicine can transplant a heart from one person to another, separate conjoined twins, and totally reconstruct knees, yet there is no established way to permanently close a tiny hole in the eyelid?)

OCULAR SURGERY NEWS EUROPE/ASIA-PACIFIC EDITION March 2005
Diode laser punctal closure an option for dry eye
Permanent punctal occlusion with a diode laser may be gentler than cautery, more effective than argon, surgeon says.
Kim Norton

"Temporary silicone punctal plug placement for dry eye patients has limitations due to the 30% to 50% rate of eventual extrusion and findings of bacterial adherence to the silicone tube, which may induce more inflammatory components in the tear film," Dr. Rice said. "A long-term solution is needed for these patients, rather than repeated punctal plug placement."

Argon laser punctal closure has been reported to have a low success rate (10%), possibly due to the inability to cauterize the canalicular area sufficiently, Dr. Rice said. A smooth occluded surface was the treatment endpoint in argon laser studies rather than destruction of tissue, he said. Thermal cautery has higher reported success rates (70% to 90%), but it is difficult to precisely control the selective cauterization of the canalicular ring. Control of the depth and duration of cauterization and the exact temperature are challenging, he said.

Success of diode laser punctal closure was defined as either complete punctal closure or a pinpoint opening, he said. The success rate was 49 of 54 (90%) with no cases of epiphora following laser punctal closure.

Punctal closure correlated with an improvement in punctate keratopathy and tear film stability as well as lessening of dry eye symptoms, he added.

"Permanent punctal closure with the 532-nm diode laser is a safe and successful adjunct in the management of patients with moderate to severe dry eye disease," Dr. Rice said.