Transcanalicular diode laser assisted dacryocystorhinostomy: A breakthrough in the treatment of acquired nasolacrimal duct obstruction.

Muhammad Awais,Muhammad Shahid,Syed Abid Hassan Naqvi,Amjad Akram

doi:10.12669/pjms.36.4.1906

Abstract

Objective:To evaluate the success rate of Transcanalicular Diode laser assisted Dacryocystorhinostomy (TC-DCR) in cases of acquired nasolacrimal duct obstruction (NLDO).Methods:This Quasi-Experimental study was conducted in Armed Forces Institute of Ophthalmology (AFIO) Rawalpindi, from July 2018 to April 2019. In this study, 73 patients of chronic dacryocystitis secondary to acquired NLDO were treated by TC-DCR under general anaesthesia. Follow up examination was done after one day, one week and three months. Silicone tubes were removed three months after surgery and syringing of lacrimal system done to confirm patency of lacrimal passages. Success of the procedure was documented as absence of epiphora and patent nasolacrimal duct on syringing.Results:Seventy three patients (males 27; females 46) were included in this study. Mean age of these patients was 51.6+21 years. On completion of this study which was three months after surgery, we found subjective improvement (absence of epiphora) in 86.3% patients and objective improvement (successful irrigation of lacrimal passages) in 93.2% patients.Conclusion:TC- DCR is a minimally invasive technique of doing Dacryocystorhinostomy and imparts more than 90% success rate. It has additional advantages of good cosmetic results, low complication rate and short surgery and convalescence time.

Highlights

Chronic dacryocystitis is chronic inflammation of lacrimal sac and its most common cause is occlusion of nasolacrimal duct.[1]
Treatment of choice for chronic dacryocystitis is dacryocystorhinostomy (DCR) in which a permanent passage is created between lacrimal sac and nasal cavity
The recent advancement in DCR technique is doing it via transcanalicular approach, in which osteotomy is created with the help of diode laser.[4]

Summary

INTRODUCTION

Chronic dacryocystitis is chronic inflammation of lacrimal sac and its most common cause is occlusion of nasolacrimal duct.[1]. DCR through external approach, due to high success rate (>90%) remained the gold standard technique for decades.[3] Caldwell in 1893 described an alternative to DCR by doing it via endonasal approach with the help of nasal endoscope.[3] Later on, because of the innovation. The recent advancement in DCR technique is doing it via transcanalicular approach, in which osteotomy is created with the help of diode laser.[4] Diode laser assisted TC-DCR has some additive advantages as it can be done under local anesthesia, causes precise cutting and removal of tissue by ablation, is bloodless, less time-consuming, leaves no external scars and can be repeated.[5,6] It can be used to treat failed Ex-DCR.

METHODS

RESULTS

DISCUSSION

CONCLUSION