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Clinical Trial
. 2018 Nov 16;23(1):58.
doi: 10.1186/s40001-018-0355-4.

Transcanalicular laser dacryocystorhinostomy for acquired nasolacrimal duct obstruction: an audit of 104 patients

Joel M Mor  1 , Mario Matthaei  2 , Holger Schrumpf  3 , Konrad R Koch  2 , Edwin Bölke  4 , Ludwig M Heindl  2
Affiliations
Clinical Trial

Transcanalicular laser dacryocystorhinostomy for acquired nasolacrimal duct obstruction: an audit of 104 patients

Joel M Mor et al. Eur J Med Res. .

Abstract

Purpose: External dacryocystorhinostomy (DCR) is considered as the gold standard in the treatment of acquired nasolacrimal duct obstruction. However, many advances have been made towards the development of modern minimally invasive therapies. These new techniques were proven less harmful to the patients' skin and medial palpebral structures with their palpebral-canalicular pump mechanism. Options include endonasal and transcanalicular procedures. Here, we report on our 2-year experience with the surgical technique, results and complications of transcanalicular laser-assisted DCR.

Methods: This is a retrospective study. A total of 104 patients with acquired nasolacrimal duct obstruction underwent transcanalicular laser-assisted DCR combined with bicanalicular silicon intubation. We then analyzed intra-/post-operative complications and subjective and objective success rates. The institutional ethics committee ruled that approval was not necessary. The trial was registered with the German Clinical Trials Register (DRKS00012879).

Results: Transcanalicular laser-assisted DCR in combination with bicanalicular silicon intubation could be performed surgically successfully in 101 patients (97%). In three cases (3%) using the superior canalicular approach, positioning of the laser instrument at the anteroinferior rim of the middle turbinate failed. Complications included thermal injury to the canaliculus (one), canalicular infection (two) and silicon tube prolapse (ten). Functional success (resolution of preoperative symptoms) was achieved in 80 cases (77%), functional failure occured in 24 cases with all patients reporting persisting epiphora, 15 reporting failure to irrigate the nasolacrimal duct and 15 requiring secondary external DCR.

Conclusions: Laser-assisted DCR shows promising results with few complications. It seems well suited as a second-step procedure after failed recanalization and before external DCR.

Keywords: Dacryocystorhinostomy; Laser; Nasolacrimal duct obstruction; PANDO; Transcanalicular.

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Figures

Fig. 1
Fig. 1
Schematic display of primary acquired nasolacrimal duct obstruction treated by laser-assisted dacryocystorhinostomy. a An infrasaccal obstruction of the nasolacrimal duct leads to epiphora. The canaliculi are unobstructed. b A laser fiber is positioned in the lacrimal sac, aiming at the nasal wall to create a nasolacrimal bypass. c After the ostium has been created, tear flow is redirected through the newly formed ostium into the nasal cavity, bypassing the nasolacrimal duct obstruction
Fig. 2
Fig. 2
Laser-assisted dacryocystorhinostomy. a Laser fiber (300 µm in diameter), connected to a 810-nm wavelength diode laser, fitted into a handpiece. b Correct positioning of the laser fiber with mediorostral orientation. c Transillumination shortly before the tip breaks through the nasal mucosa at the anteroinferior rim of the middle turbinate. d A blunt metal probe guiding a silicon tube is pushed through the ostium
Fig. 3
Fig. 3
Complication rates (%) following laser-assisted dacryocystorhinostomy
See this image and copyright information in PMC

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References

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