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. 1999 Apr;83(4):443-7.
doi: 10.1136/bjo.83.4.443.

Endoscopic laser recanalisation of presaccal canalicular obstruction

A Kuchar  1 , P Novak, S Pieh, M Fink, F J Steinkogler
Affiliations

Endoscopic laser recanalisation of presaccal canalicular obstruction

A Kuchar et al. Br J Ophthalmol. 1999 Apr.

Abstract

Aim: To document the results of erbium (Er)-YAG laser treatment in presaccal canalicular obstruction in combination with the use of a flexible endoscope.

Methods: For the first time an Er-YAG laser (Schwind, Sklerostom) was attached to a flexible endoscope (Schwind, Endognost) and used to recanalise a stenosis of the upper, lower, or common canaliculus. In 17 patients (mean age 41.5 (SD 11.9) years), 19 treatments (two bilateral) were performed. In all cases the scar was observed using the endoscope and was excised by laser ablation. A silicone intubation was performed in all cases. In addition to the endoscopy an irrigation was performed to prove the intactness of the lacrimal pathway system after laser treatment.

Results: Membranous obstructions with a maximum length of 2.0 mm (14 procedures) in the canaliculus were opened easily using the laser, and the silicone intubation was subsequently performed without difficulty. Scars thicker than 2.0 mm could not be opened safely without canaliculus penetration (five procedures). Irrigation was positive in all cases up to the end of a 6 month period, providing the tubes remained in place. The maximum follow up is now 17 months (minimum 8 months) and in 16 cases (84.2%) the canaliculi are still intact.

Conclusion: Endoscopic laser treatment combined with silicone intubation enables us to recanalise presaccal stenoses of canaliculi under local anaesthesia up to a scar thickness of 2.0 mm. Best results can be achieved in cases where much tissue can be saved. Under such conditions this procedure can substitute for more invasive surgical techniques, especially a conjunctivo-dacryocystorhinostomy (CDCR).

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Figures

Figure 1
Figure 1
The laser hand piece (Schwind) with the fixed sapphire laser fibre of 350 µm.
Figure 2
Figure 2
The modified Bowman probe (Geuder) with 1.1 mm outer and 0.9 mm inner diameter. At the upper end the connection for the endoscope, in the centre the laser fibre and at the third opening the syringe may be attached. The marks in a range of 5 mm are clearly detectable.
Figure 3
Figure 3
Scarred lower canaliculus with bleeding after irrigation.
Figure 4
Figure 4
Lower canaliculus with silicone tube splinting the reopened passage after Er-YAG laser treatment.
Figure 5
Figure 5
Recanalised lower canaliculus as in Figure 4 after tube removal.
Figure 6
Figure 6
Success rate of laser reconstruction.
See this image and copyright information in PMC

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