Author’s reply

Abstract

In Dr. Berlin’s letter, he states that both Hartikainen et al in their original article, entitled “Prospective Randomized Comparison of External Dacryocystorhinostomy and Endonasal Laser Dacryocystorhinostomy,” and Dr. Santiago and I in our reply, entitled “Success Rate of Endoscopic Laser-Assisted Dacryocystorhinostomy,” neglect to note that the lacrimal sac cannot be explored satisfactorily with the endonasal laser approach. The reason that we have not done so is because this has not been our experience in over 350 cases to date.1Camara J.G. Santiago M.D. Current surgical technique of endoscopic laser assisted dacryocystorhinostomy.in: Bosniak S. Cantisano-Zilkha M. Operative Techniques in Oculoplastic, Orbital and Reconstructive Surgery. W.B. Saunders, Philadelphia1998: 66-72Google ScholarWith careful manipulation of the light source within the lacrimal sac, and vaporization of the bone adjacent to it, we are able to endoscopically visualize the sac, perform biopsies, and drain purulent material when necessary. We do not share Dr. Berlin’s 16% incidence of lacrimal stones in patients undergoing dacryocystorhinostomy, but in the rare cases that we do, these stones are readily vaporized by the Coherent Versapulse Holmium:YAG laser (Coherent Medical, Inc., Palo Alto: California) that we currently use to perform the procedure.The main purpose of our letter was to emphasize that the advantages of endoscopic laser-assisted dacryocystorhinostomy (ELA-DCR) are significant from the patient’s standpoint: (1) tissue injury limited to the fistula site; (2) absence of a cutaneous incision and the possibility of scar formation; (3) avoidance of potential injury to medial canthal structures; (4) excellent hemostasis; (5) relatively short operative time, and (6) earlier return to normal daily activities. These advantages, in our opinion, outweigh the disadvantages of the steep learning curve associated with the early performance of the operation as was the case with many new procedures in ophthalmology, most notably the phacoemulsification of cataracts. We wish to reassure other investigators that, after hurdling the initial learning curve, success rates with ELA-DCR are comparable to, if not higher than, external DCR. In Dr. Berlin’s letter, he states that both Hartikainen et al in their original article, entitled “Prospective Randomized Comparison of External Dacryocystorhinostomy and Endonasal Laser Dacryocystorhinostomy,” and Dr. Santiago and I in our reply, entitled “Success Rate of Endoscopic Laser-Assisted Dacryocystorhinostomy,” neglect to note that the lacrimal sac cannot be explored satisfactorily with the endonasal laser approach. The reason that we have not done so is because this has not been our experience in over 350 cases to date.1Camara J.G. Santiago M.D. Current surgical technique of endoscopic laser assisted dacryocystorhinostomy.in: Bosniak S. Cantisano-Zilkha M. Operative Techniques in Oculoplastic, Orbital and Reconstructive Surgery. W.B. Saunders, Philadelphia1998: 66-72Google Scholar With careful manipulation of the light source within the lacrimal sac, and vaporization of the bone adjacent to it, we are able to endoscopically visualize the sac, perform biopsies, and drain purulent material when necessary. We do not share Dr. Berlin’s 16% incidence of lacrimal stones in patients undergoing dacryocystorhinostomy, but in the rare cases that we do, these stones are readily vaporized by the Coherent Versapulse Holmium:YAG laser (Coherent Medical, Inc., Palo Alto: California) that we currently use to perform the procedure. The main purpose of our letter was to emphasize that the advantages of endoscopic laser-assisted dacryocystorhinostomy (ELA-DCR) are significant from the patient’s standpoint: (1) tissue injury limited to the fistula site; (2) absence of a cutaneous incision and the possibility of scar formation; (3) avoidance of potential injury to medial canthal structures; (4) excellent hemostasis; (5) relatively short operative time, and (6) earlier return to normal daily activities. These advantages, in our opinion, outweigh the disadvantages of the steep learning curve associated with the early performance of the operation as was the case with many new procedures in ophthalmology, most notably the phacoemulsification of cataracts. We wish to reassure other investigators that, after hurdling the initial learning curve, success rates with ELA-DCR are comparable to, if not higher than, external DCR.