"Smart Plug"

[Jen72]

Has anyone ever tried these?? I am entitled to about one more visit at my Lasek surgeon and I need a more permanent solution. (Of course I can see her anytime except now I have to pay !?!) My umbrella type plugs keep falling out. Plugs seem to be the only thing that works for me. The Dr. says cautery is an option and can be easily reversed (not-from my research). ANy input would be great, this has been a great resource during this whole nightmare of laser induced dry eye.

[brd888]

Cautery

Cautery is a permanent procedure as far as I am aware.
I got a smart plug - although it didn't help for my problem. Some docs dont like them because once they are in you can't tell if it is there or not.

[Jen72]

cautery

I went back to the Dr. today. She really wont consider intracanicular plugs and is pushing cautery. Basically my punctum wont seem to hold the plugs, she says that the smart plug etc. would just migrate out due to my large opening. Thus, that is why I keep losing plugs. Dont know what to do- cautery is so permanent. Any suggestions?

[Lucy]

Get another doctor. Ask this doctor is he knows a doctor who might consider plugs for you. Perhaps he's just not experienced or doesn't want to bother.

You can also go to the yellow pages and see if you can find any docs who specialize in dry eye. Cautery is to be considered permanent. It often needs to be repeated as it doesn't always work. I don't think this doc is giving you the attention you need to get plugs placed so they will work.

Good luck and don't give up. Cautery is available if nothing works. I can't believe she said it's reversible. Bad doc. Lucy

[indrep]

Jen
While technically cauterization is reversible it is not a simple procedure. You might ask your "caring" surgeon about Extended Duration Synthetic plugs. These are intracanlicular and are effective for about 90 days. If this works then there is another type of intracanalicular plug that is a hydrogel material(90% water when hydrated) that is indeed easy to reverse if need be. ( I have an interest in this plug)

[Rebecca Petris]

I've used SmartPlugs. Their claim to fame is comfort. I am not a fan, because of reported and anecdotal complications.

I wouldn't do cautery under pressure, and certainly not without doing sufficient experimenting with creative plug alternatives such as indrep suggests. He always has good advice and knows as much about plugs as anybody I know.

[Jen72]

Thank you for your replies, as always reassuring and astute.

Lucy, I agree its probably time to find a good doc.


Well, I went ahead with cautery of one of the punctum, I see it as an eventuality so I went ahead. But instead of doing both bottom punctum my surgeon would only do one (other is plugged). If the other unplugs then cautery on that one too. She was very resistant towards any intracanicular plugs due to migration and in my case size of punctum. All signs look that this DES will be long term so cautery made sense.

Indrep- Should I leave well enough alone and stay with one punctum cauterized and the other plugged. Or find a doc that will do canal plugs?

Dunno, going to try to enjoy the holiday. Merry Christmas everyone!!

[indrep]

Jen,
I would try to find a doc who was willing to insert the Extended Duration plugs. I would see how that felt then make a decision on intracanlicular plugs or cautery. I believe cautery is at best a last resort, but that is only my opinion.

[Redbirdi]

Cautious of "Smart Plugs"

Oh my, the thought of someone else going with “Smart Plugs”! I had a very bad experience with them and months of infection and difficulty getting them out, even with the doctor’s extensive treatments and flushing them. (posted on the boards Ongoing and recurring infection from Smart Plugs 07-Jul-2008) It’s been over a year since all the problem and infection started. One eye at a time. Six months of infection and ongoing treatment on the first one and a couple of months later on the other.

I was told the only option for me now is cautery. I do need to do something as my DES continues to be severe and w/o plugs I can really tell the difference. I am curious about the hydrogel material plug mentioned by indrep -especially the part about it being easily reversed. Any more information on that? I will be returning to my eye doctor later in January and need to look into the next step.

(I will be looking over the boards here for more info on cautery so any suggestions please let me know.)

Thanks,
Rose

[Jen72]

Yes, in hindsight I am glad I stayed away from smart plugs. I will probably just go ahead with cautery on my second bottom punctum. For me I think it will happen eventualy and I am weary of complications of ic plugs.

Redbirdi- I had cautery a few days ago and it is still a little sore, but it seems to be effective. It was a minor procedure in the office, the numbing is the most painful part but its quick. It was the same cost as one plug ($200-before ins.) and as I lose 1-2 plugs a month it made sense for me to go with cautery. Even one days without plug and I start a cylcle of severe dryness that lead to dry spots on my cornea. best wishes - Jen

[indrep]

Rose,
The hydrogel plug is inserted into the vertical canaliculus. This is different than other intracanalicular plugs which are inserted into the horizontal space. This is key when trying to remove the plug. The hydrogel plug can be gentley pushed up through a dilated punctal ring or with irrigation the plug desintegrates into a mucous like substance and is washed out. The plug is called Form fit from OASIS.