Endocanalicular Laser Dacryocystorhinostomy Research Articles

Trans Canalicular Diode LASER DCR with ‘Bari Device’ in Pediatric Cases

Epiphora due to Nasolacrimal duct obstruction (NLDO) is common in chidren. About 5% to 20% infants show evidence of congenital Nasolacrimal duct obstruction with symptoms 1,2. Most of them (95%) cured by conservative management. Majority of the remaining symptomatic patients are cured by probing, repeat probing, probing with incubation and Baloonplasty procedures. About 4% of the patients need surgical intervention. Conventional Dacryocystorhinostomy (DCR) is the main treatment of choice in these cases till to date. DCR means creation of an alternate pathway between lacrimal sac and nasal cavity to drain tear when nasolacrimal duct (NLD) is blocked. There are different surgical techniques available for DCR. These includes conventional or external DCR, endoscopic DCR, endoscopic Laser DCR, transcanalicular or endocanalicular Laser DCR. In adult DCR can be carried out comfortably by the conventional or newly developed endoscopic approach. Narrow space, inadequate development of anatomical landmark makes both the conventional & endoscopic DCR difficult in children. Long term success rate of External DCR in pediatric patients is less in comparison to adult due to vigorous growth of tissue in a child. Laser DCR has been tried but long term success rate is not up to the mark. Several observations like- primary osteum closure, cicatrix formation with middle turbinate and nasal septum, granulation tissue formation- all are more in children due to marked fibroblastic response. So Laser DCR is a challenge in pediatric patients.

Endocanalicular Laser Dacryocystorhinostomy With Mucosal Flaps

To describe the technique of endocanalicular laser dacryocystorhinostomy with mucosal flap creation and to report the outcomes of this technique. Prospective noncomparative case series of 7 patients with primary acquired nasolacrimal duct obstruction undergoing endocanalicular laser dacryocystorhinostomy with mucosal flap. The mucosal flap was created using an endoscopic endonasal approach. An endocanalicular approach was used to fashion the lacrimal sac opening and the osteotomy of the lacrimal sac fossa. Nine procedures were performed in 7 female patients. Average patient age was 68±15 years. Intraoperative complications included bleeding during the creation of the mucosal flap in 1 patient. The procedure was associated with no pain to moderate pain in all cases. Anatomical success was achieved in 89% of procedures and symptomatic relief was achieved in 89% of surgeries for an average follow up of 10 ± 5 months. Only 1 patient required an external dacryocystorhinostomy revision because of postoperative restenosis. Endocanalicular laser dacryocystorhinostomy provides a minimally invasive approach to epiphora with a good success rate. The addition of a nasal mucosal flap to this technique may aid in proper fistulization and should be studied in larger prospective trials.

Laser-assisted dacryocystorhinostomy

Improvements in endoscopic instrumentation and evolving laser technologies have renewed interest in laser-assisted endonasal applications, and an increasing number of lacrimal surgeons have focused on laser-assisted approaches to dacryocystorhinostomy (DCR). The purpose of this review was to assess the clinical efficacy of laser-assisted DCR techniques with a particular focus on the endocanalicular approach and to describe various laser systems and their associated tissue effects. Recent studies of endocanalicular laser DCR suggest favorable success rates that are comparable with external and endonasal endoscopic DCR, although there is a shortage of robust, prospective, randomized studies. Recent evidence suggests that endocanalicular laser DCR is a well tolerated, viable treatment option for nasolacrimal duct obstruction in selected patients with favorable results and shorter operative times. More recent studies seem to suggest improvements in success rates compared with older studies, although additional, well designed, comparative studies are needed.

Pediatric endocanalicular diode laser dacryocystorhinostomy: results of a minimally invasive surgical technique

The purpose of this study was to evaluate the effectiveness of endocanalicular diode laser dacryocystorhinostomy (DCR), which is a minimally invasive surgical technique, in pediatric patients with congenital nasolacrimal duct obstruction (NLDO). A retrospective study was carried out on patients treated between October 2008 and August 2009 for nasolacrimal duct obstruction with an endocanalicular diode laser procedure. Patients diagnosed as having nasolacrimal duct obstruction were included in this study and an endocanalicular diode laser procedure was performed. The main outcome measures were patients' previous treatments, clinical presentation, operative and postoperative complications, postoperative follow-up and resolution of epiphora. Eighteen children (10 girls, 8 boys) with a mean age of 6.11 ± 2.08 years (range, 4-10) underwent 20 endocanalicular laser DCR operations for congenital NLDO. In all eyes (100%), there was a history of epiphora and chronic dacryocystitis; two (10%) presented with acute dacryocystitis. Previous procedures included probing and irrigation of all eyes (100%) and silicone tube intubation in nine eyes (45%). None of the patients underwent any previous DCR operations. During a mean postoperative follow-up period of 20.50 ± 3.24 months (range, 14-24 months), the anatomical success rate (patency of ostium on nasal endoscopy) was 100%, and the clinical success rate (resolution of epiphora) was 85%. Endocanalicular diode laser DCR is an effective treatment modality for pediatric patients with congenital NLDO that compares favorably with the reported success rates of external and endoscopic endonasal DCR. Moreover, it has an added advantage of shorter operative time, less morbidity and avoidance of overnight admission.

Comparison of endocanalicular laser dacryocystorhinostomy with and without endonasal procedures

To evaluate the role of concomitant endonasal procedures in endocanalicular diode laser dacryocystorhinostomy (DCR). This was a retrospective study, conducted on adult patients with primary acquired nasolacrimal duct obstruction. Thirty-one (seven bilateral) patients formed group 1 and 37 (five bilateral) patients group 2. Group 1 underwent endocanalicular laser DCR. In group 2, concomitant endonasal procedures, namely middle turbinectomy and endonasal mechanical enlargement of the neo-ostium were additionally performed. Mean follow-up period was 14.6 months for group 1, and 11.0 for group 2. Functional success was defined as the absence of epiphora, and anatomical success as the ability to irrigate the lacrimal system. Anatomic and functional success at each visit were compared using chi-square tests (p < 0.05). Total laser energies used for each case were compared using the Mann-Whitney U test (p < 0.05). Anatomical success rates were increased at the third month, sixth month and final visits. The increase was statistically significant. P value was 0.04 for the third and sixth month results comparison. Final anatomical success rates were 27/38 for group 1 and 39/42 for group 2 (p = 0.02). Final functional success rates were 25/38 patients in group 1 and 36/42 in group 2 (p = 0.07). Mean total laser energy used decreased from 300.0 to 165.0 joules (p < 0.001). Based on our increased anatomical success rates, concomitant endonasal procedures may help increase success rate in endocanalicular diode laser DCR cases.

Endocanalicular Diode Laser Dacryocystorhinostomy for Nasolacrimal Duct Obstruction

To evaluate the results, complications, effectiveness, and operative results of the endocanalicular laser dacryocystorhinostomy (ECL DCR) in the distal obstructions of the lacrimal drainage system. Sixty eyes of 57 patients who had a diagnosis of distal obstruction of the lacrimal drainage system were evaluated retrospectively in this study. All patients underwent ECL DCR by diode laser between October 2008 and July 2009. Forty-nine patients (86%) were females, 8 patients (14%) were males, and age distribution was between 3 and 84 years old (median, 40 y). The canaliculi were intubated by a silicone tube. The patency of the nasolacrimal system was controlled by lacrimal lavage, loss of epiphora, and endoscopic evaluation of the endonasal rhinostomy site with routine follow-up scheduled at first day and 1-week, 1-month, and 3-month postoperative intervals. After the 60 ECL DCRs, 10 patients underwent revision ECL DCR because of the persistent epiphora. The patency of the nasolacrimal duct or the decrease of the symptoms was assigned as success. There were no symptoms at all in 83.3% of the patients. The ECL DCR in the treatment of the distal obstructions of the lacrimal drainage system was easily tolerated by the patients, cosmetically preferred because there was no incision and scar formation with high success rates, and a minimally invasive alternative technique.

Use of endocanalicular dacryocystorhinostomy with multidiode laser in children

Objective To evaluate the clinical outcome and efficacy of endocanalicular laser dacryocystorhinostomy using a multidiode laser in cases unresponsive to medical therapy, probing or intubation of pediatric nasolacrimal duct obstruction. Methods Eight children with nasolacrimal duct obstruction were treated with a multidiode laser. The study was prospective, non-randomized, and noncomparative. The patients, 2 (25%) males and 6 (75%) females, ranged in age from 8 to 13 years (mean 11.25 ± 2.43). Surgery was performed under general anesthesia. All procedures were performed using a multidiode laser. The nasal passage was visualized with a 30° nasal video endoscope. In all cases, silicone stents were inserted. The main outcome measure was resolution or improvement of the epiphora and no major laser damage intranasally. Patients were followed for at least 6 months. Results The endocanalicular laser dacryocystorhinostomy failed in one of the 8 (12.5%) cases, which had been secondary to trauma. The others were due to primary nasolacrimal duct obstruction. External dacryocystorhinostomy was performed on the failed case. None of the cases with primary nasolacrimal duct obstruction had obstruction after the endocanalicular laser dacryocystorhinostomy operation. Conclusions Endocanalicular laser dacryocystorhinostomy using a multidiode laser appears to be an effective technique in cases unresponsive to medical therapy, probing or intubation of primary nasolacrimal duct obstruction.

Use of the Diode Laser With Intraoperative Mitomycin C in Endocanalicular Laser Dacryocystorhinostomy

To determine the safety and efficacy of the diode laser with intraoperative mitomycin C in endocanalicular laser dacryocystorhinostomy (ECL-DCR). In a prospective case series of 40 ECL-DCRs using the diode laser, mitomycin C was placed intraoperatively in all cases. The main outcome measure was resolution or improvement of epiphora and no major laser damage intranasally. Patients were followed for at least 18 months. Forty consecutive ECL-DCRs on 30 patients (23 females, 7 males, mean age 62 years) were performed from April 2000 to December 2001. The success rate at 12 months postoperatively was 87.5%. All failures were due to a constricted nasal osteotomy. No significant intraoperative or postoperative complications were recorded. Diode laser ECL-DCR with mitomycin C appears to be a safe and effective treatment modality for primary acquired nasolacrimal duct obstruction.

Endocanalicular Laser Dacryocystorhinostomy: Analysis of 118 Consecutive Surgeries

To describe the outcomes of endocanalicular laser dacryocystorhinostomy (ECL DCR) for patients with nasolacrimal duct obstruction (NLDO). Retrospective, noncomparative, interventional case series. One hundred eight consecutive patients who underwent ECL DCR. The records of the patients who underwent ECL DCR at 1 of 2 academic centers were reviewed and the data analyzed. Success was defined as the resolution of symptoms or unobstructed lacrimal irrigation. One hundred eighteen consecutive ECL DCR surgeries performed on 108 patients between June 1997 and June 2003 were reviewed, excluding 6 lost to follow-up. Endocanalicular laser DCR was the initial surgical intervention for all cases except 6 that had previously undergone surgery (external or endonasal DCR) at outside hospitals. Twenty-seven of the surgeries were considered failures on the basis of recurrent epiphora or discharge, or reflux on nasolacrimal irrigation. One of the failures was permanently corrected with balloon dacryoplasty. Nine of the other failures had a repeat procedure, with 7 remaining patent after one repeat procedure and an additional one remaining patent after a third procedure. All 6 ECL DCR procedures that were performed after external or endonasal DCR at an outside institution remained patent. Among the 102 initial lacrimal surgeries in this series, there was a 73.6% success rate. The overall success, including repeat procedures, was 81.5%. The success of this technique as a repeat procedure after previous external, endonasal, or ECL DCRs was 87.5%. Endocanalicular laser DCR offers a minimally invasive alternative procedure for the treatment of NLDO. In our series, the success rates are comparable to those previously reported. The technique had a high success rate when used to treat recurrent NLDO after previous lacrimal surgery.