Innovative Solutions for Swift Enhancement: A Case Series on Filamentary keratitis treatment with Plasma Occlusion of Puncta

Purpose: This study aimed to evaluate the effectiveness of plasma occlusion of punctum (POP) in treating filamentary keratitis (FK) secondary to severe dry eye disease (DED). Methods: This study included five patients diagnosed with FK secondary to severe DED, concurrent with immunologic disorders. Patients received three POP sessions at one-week intervals. The POP procedure involved applying one or two plasma spots on the punctum using the PLEXR PLUS device, leading to punctum stricture for about six months. Visual and dry eye parameters, including best corrected visual acuity (BCVA), tear meniscus height (TMH), tear break-up time (TBUT), corneal fluorescein staining (CFS), intraocular pressure, and the Ocular Surface Disease Index (OSDI), were measured before treatment, one week after the first session, and six months after the third session, and also slit-lamp examinations were conducted to assess FK signs and possible complications. Results: BCVA improved by two lines in two patients and by one line in another. The OSDI score showed a significant improvement, increasing by 65.26% over six months. The DED grade improved in all patients. TMH and TBUT showed significant increases, and CFS grades decreased, indicating enhanced tear film stability and ocular surface health. All patients showed significant improvement in FK symptoms, with four achieving complete healing after one session and one patient after two sessions. Conclusion: POP seems to be an effective treatment for FK associated with severe DED, providing swift improvements in tear film stability, and FK management.