Had smartplug removal surgery. It was successful medically BUT, and I'm not sure how

[anne1232]

to get this in the right place here, the BUT being that is has wiped me out financially. Insurance, which I supposedly have, figured out a way to not pay for most of it. Had the surgery in June, and bills are still coming in...the issue is, I wanted to go to small claims court against Meddillum (sp?- don't have my paperwork right now) just for the out of pocket costs. SO- the point is, before the surgery I went in to see the doctor to specifically ask him to retain the plug or pieces of it. I had a paper for him to sign saying he would. He refused to sign it, removed the plug (according to the surgery notes there was indeed the smartplug causing the whole deal) then THREW THE PLUG AWAY. The doctor who inserted them has "lost" all my records. I guess this question is for a doctor- I believe that I "owned" the plug, and should been able to receive the pathology reports showing the plug. The report just says 'infected tissue.' It seems similar to me to a doctor removing a defective breast implant- an implant know to be defective, then tossing it so the patient has no legal recourse. My question to a doctor would be- as lawyers have advised (none can take the case as obviously there's no evidence) - can I report this to the Medical Board? It's all too late for me, but he should not have a "policy" of throwing out something patients paid for and 'belongs' to them???? Clearly doctors are very frightened of this.

[MelissaK]

I'm so sorry you are wiped out financially and I don't have any advice to offer about the insurance situation. But I wanted to tell you that your message offers me hope I have been looking for! I had no idea it was possible to surgically remove the smartplugs!

I am 12 years post-lasik and had SmartPlugs for the last 8 years. I thought they were an answer to my prayers and provided me with great relief. But suddenly in 2009 I began getting recurring infections and finally had all four puncta irrigated in 2012 to get rid of the plugs. However, the lower right continues to ooze pus and be itchy. My optometrist is unable to get saline through (has tried on four separate occasions and is successful with my other puncta). But two different ophthalmologists are able to irrigate easily and therefore claim nothing could possibly still be left behind. I honestly believe the plug is at least partially still in there and is causing inflammation. How did you get your ophthalmologist to agree to surgery? Had he been able to pass saline through prior to surgery? What was the surgery like?

Anyone have suggestions for doctors who have some experience with this in Nebraska? Or even somewhere in the Midwest? I am willing to travel but I don't want to take the time and money to do so just to be told once again that there is nothing that can be done. Thanks!

[cristinalatina]

I'm so sorry about your experience. I also have 4 smart plugs in. What kind of surgery is this?

Are the doctors denying to testify on your behalf? I would definitely report this. You had the right to hold onto the evidence.

[cristinalatina]

I began getting recurring infections and finally had all four puncta irrigated in 2012 to get rid of the plugs. However, the lower right continues to ooze pus and be itchy. My optometrist is unable to get saline through (

Melissa, I am very sorry you have trouble with that one punctum. Did your symptoms resolve completely in the other 3 after the irrigations? Did you also take antibiotics?

[MelissaK]

Melissa, I am very sorry you have trouble with that one punctum. Did your symptoms resolve completely in the other 3 after the irrigations? Did you also take antibiotics?

Yes, symptoms resolved completely in other 3 after irrigations. I took antibiotics prior to the irrigations, both topical and oral, about 15 different times trying to clear up these infections. Removing the plugs was really a last resort for me because they had worked so well for my dry eyes for so many years. After removal, however, I did not take antibiotics. Everything cleared up immediately except in the one punctum.

[spmcc]

I had my 4 Medennium Smartplugs flushed in 2009 due to canaliculitis (you could "milk" my puncta). Anyway, I guess I was lucky because I've had no problems since.

There are tons of published reports about problems with Smartplugs (e.g., http://www.revophth.com/content/d/fe.../1448/c/27348/).

I would keep looking for a doctor who knows what he/she is doing. Search DEZ using the term "smartplug". I know there's a post that discussed the SmartPlug Study Group. Perhaps a doctor in that group is close to you:

The SmartPlug Study Group consists of the following authors: Joseph A. Mauriello, Jr, MD, private practice, Summit, New Jersey and University of Medicine and Dentistry of New Jersey, Newark, New Jersey; Bita Esmaeli, MD, University of Texas M. D. Anderson Cancer Center, Houston, Texas; Amjad Ahmad, MD, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois; Kathleen F. Archer, MD, private practice, Houston, Texas; Thomas A. Bersani, MD, Eye Plastic and Reconstructive Surgery of Central New York, Syracuse, New York; Kenneth V. Cahill, MD, Ophthalmic Surgeons and Consultants of Ohio, Inc., Columbus, Ohio; Karen L. Chapman, MD, University of South Florida Tampa, Sarasota Memorial Hospital, Sarasota, Florida; Kenneth A. Feldman, MD, private practice, Harbor City, California; James W. Gigantelli, MD, University of Nebraska Medical Center, Omaha, Nebraska; Andrea N. Hass, MD, private practice, Palm Beach Gardens, Florida; Jemshed A. Khan, MD, Khan Eyelid and Facial Plastic, Overland Park, Kansas; Paul D. Langer, MD, private practice, Newark, New Jersey; William J. Lipham, MD, Minnesota Eye Consultants, P.A., Bloomington, Minnesota; Don Liu, MD, University Physicians of Missouri, Columbia, Missouri; Thaddeus S. Nowinski, MD, private practice, Lansdale, Pennsylvania; B. C. K. Patel, MD, Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah; Rona Z. Silkiss, MD, California Pacific Medical Center, San Francisco, California; Valerie Vick, MD, Premier Medical Group, Mobile, Alabama.

Good luck. I hope everything works out.

[cristinalatina]

Good luck Melissa. My understanding is that a "curettage" (slicing open the punctum and removing material, and it heals back without stitches or anything) is invasive, but a radical solution, and far better than a dcr. I wish you complete recovery!

[farmgirl]

Do you actually, physically need the plug to sue. Would it not be enough to have the Dr. report saying what the problem was and what was done about it. I don't know if you have ever laid eyeballs on a plug but I have one in my purse and you almost need a microscope to see it. I am not sure what you would be able to see of one that was surgically extracted.

[MelissaK]

I had my 4 Medennium Smartplugs flushed in 2009 due to canaliculitis (you could "milk" my puncta). Anyway, I guess I was lucky because I've had no problems since.

There are tons of published reports about problems with Smartplugs (e.g., http://www.revophth.com/content/d/fe.../1448/c/27348/).

I would keep looking for a doctor who knows what he/she is doing. Search DEZ using the term "smartplug". I know there's a post that discussed the SmartPlug Study Group. Perhaps a doctor in that group is close to you:



Good luck. I hope everything works out.

Got an appointment with Dr. Gigantelli in 2 weeks! Thanks so much!!!

[spmcc]

Got an appointment with Dr. Gigantelli in 2 weeks! Thanks so much!!!

Good luck. Please let everyone know what happens and how it all goes. Fingers crossed for you!

[MelissaK]

Saw Dr G this afternoon and he agrees surgery is the way to go to remove the plugs. Thanks for the support and prayers! I'm so glad I found this site!!

[cristinalatina]

Saw Dr G this afternoon and he agrees surgery is the way to go to remove the plugs. Thanks for the support and prayers! I'm so glad I found this site!!

What kind of surgery, Melissa? Does he expect that the surgery will complicate your lacrimal function/dry eye?

[MelissaK]

The surgery is the "curretage" mentioned earlier in this thread. He will slice open the punctum until he finds and removes the plugs. A side effect of curretage is that the punctum can scar shut, similar to having it cauterized, which in my case would be just fine because having all four puncta plugged was great for my dry eyes until all the infections began. He said my case of SmartPlug-induced infection happening years after they were inserted was textbook--he sees it all the time

[MelissaK]

Just wanted to update everyone...I had the SmartPlugs surgically removed last Wednesday, May 8th. In the upper right, Dr Gigantelli found 1 plug plus 2 dacryoliths (or "stones" that form as a result of a specific kind of bacteria living in the puncta. This bacteria is a "cousin" to TB and is attracted thermo-acrylic material, which is what SmartPlugs are made out of) and 1.5 plugs in the lower right. He then used a tool he referred to as an "ice-cream scoop" and scraped out the rest of the punctum just to be sure nothing was left behind. My eyes are *definitely* dry again, but I am relieved the disgusting bacteria-laden foreign bodies are gone. I'm still thinking about what my next step will be. Dr. G said he sees about 2 patients a month with "SmartPlug-induced infection occurring 5+ years after insertion where plugs cannot be successfully irrigated and must be surgically removed."

[spmcc]

Hi Melissa,

I'm so happy that the infection and plugs are gone! But I'm so sorry that you're back to dry dry dry. Did Dr. Gigantelli give you any ideas of how to 'safely' block your puncta now? I'm glad that he's so good at removing SmartPlugs, but is he someone you'd continue to see for dry eyes?

Happy healing.
Sheila