Endonasal Laser-assisted Dacryocystorhinostomy Research Articles

Endolaser assisted DCR for nasolacrimal duct obstruction

Objective: The objective of this prospective case series study is to evaluate the clinical outcome of endonasal laser assisted Dacryocystorhinostomy (ENL-DCR) using diode laser 810 in patientsMaterial and Methods:Fifty four patients with age range from(10-55)years where included in the study which performed at Diwannyia teaching hospital(from April 2013 to June 2014).Patients were followed for 6-12 months..Success of procedure was absence of epiphora (subjective) or patency of lacrimal system on irrigation (objective).

A meta-analysis of primary dacryocystorhinostomy with and without silicone intubation

Objective To examine possible differences in success rates of primary dacryocystorhinostomy (DCR) with and without silicone intubation, and to find out whether the use of silicone tubes is beneficial. Design A literature search was conducted in the PubMed, EMBASE, and Cochrane Controlled Trials Register to identify potentially relevant controlled trials. Methods Language was restricted to English. The surgical techniques were categorized into external DCR (EX-DCR), endonasal laser-assisted DCR (LA-DCR), and nonlaser endoscopic endonasal DCR techniques (EN-DCR). The main outcome measure was success rates after DCR-with and DCR-without silicone intubation. The statistical analysis was carried out using a RevMan 5.0 software. Results Of 188 retrieved trials from the electronic database, 9 trials (5 randomized controlled trials and 4 cohort studies) involving 514 cases met our inclusion criteria. There was no statistically significant heterogeneity between the studies. The pooled risk ratio was 0.99, with a 95% confidence interval (0.91–1.08). There was no significant difference in the success rates between the DCR with and without silicone intubation ( p = 0.81). Sensitivity analysis and subgroups analyses suggested that the result was comparatively reliable. Conclusions Based on this meta-analysis that included 5 randomized controlled trials and 4 cohort studies, no benefit was found for silicone tube intubation in primary DCR. Further well-organized, prospective, randomized studies involving larger patient numbers are required.

A Systematic Review of Outcomes after Dacryocystorhinostomy in Adults

This study was designed to systematically review the clinical outcomes of dacryocystorhinostomy (DCR) surgery. Data sources included PubMed for English language literature from January 1966 to December 2008 combined with a manual review of citations within article bibliographies. Citations acquired from the targeted search were filtered independently by two researchers. Relevant articles were reviewed to obtain information including interventions and outcome measures. The surgical techniques were categorized into external DCR (EX-DCR), endonasal laser-assisted DCR (LA-DCR), and nonlaser endoscopic endonasal DCR techniques (EN-DCR). Articles were then assigned level-of-evidence grades as defined by the Oxford Center for Evidence-Based Medicine. A total of 73 studies that fulfilled the inclusion criteria were analyzed. Of these, 68 were graded as level 4, 11 were graded as level 3b, and 1 was graded at level 2b evidence. A total of 4800 patients were pooled, from which 4921 DCRs were performed. All studies reported success during the follow-up period, although the outcome measures used were not consistent in the studies. Success varied between 65 and 100% after EX-DCR compared with EN-DCR, which varied from 84 to 94%. The success rate of LA-DCR varied widely between 47 and 100%. There was low evidence base to support the use of silicone stent to improve surgical success. Most studies did not show significantly improved outcomes with an antimetabolite. The overall intra- and postoperative complication rates were 1.0 and 6%, respectively. DCR is an effective and safe method for the treatment of nasolacrimal obstruction. Meta-analysis of outcomes was not feasible because of the heterogenous patient groups and outcome measures used. Nonetheless, the literature provides considerable levels 3 and 4 evidence to support DCR surgery in adults. Outcomes after EN-DCR and EX-DCR were comparable. The failure rate for LA-DCR was higher.

Endoscopic ‘cold steel’ versus laser dacryocystorhinostomy: completing the audit cycle

Dacryocystorhinostomy via an endonasal route has been adopted in our department. This audit study describes and compares our results for external, laser endonasal and 'cold steel' endonasal techniques. Success was defined as a subjective report of eye watering being 'better' or 'cured'. Data were obtained from a retrospective review of the medical records of all patients undergoing primary dacryocystorhinostomy in our department. 'Gold standard': External dacryocystorhinostomy performed by a consultant ophthalmologist was taken as our gold standard. In our study, the success rate for external dacryocystorhinostomy was 94 per cent. First cycle - laser-assisted endonasal dacryocystorhinostomy: Our initial results for endonasal laser-assisted dacryocystorhinostomy produced a success rate of 64 per cent, which was significantly worse than that for external dacryocystorhinostomy. These results have been previously published. Evidence suggested that cold steel endonasal dacryocystorhinostomy was more effective, and we adopted this as our technique of choice. Second cycle - cold steel endonasal dacryocystorhinostomy: Over a four-year period, 57 cases completed a full nine months' follow up. 93 per cent were completed as day cases and 39 per cent were performed under local anaesthetic. The success rate was 79 per cent (45/57). There was no difference in success rates when this procedure was compared with external dacryocystorhinostomy (p = 0.55). The type of anaesthetic used (i.e. local vs general) made no difference to the success rate (p = 0.93). Cold steel endonasal dacryocystorhinostomy was as effective as the gold standard, i.e. external dacryocystorhinostomy. Laser-assisted dacryocystorhinostomy was significantly less successful than external dacryocystorhinostomy. Due to the benefits of decreased operating time, lower morbidity and success under local anaesthetic, we recommend cold steel endonasal dacryocystorhinostomy as our procedure of choice for the treatment of epiphora.

Clinical outcome of endonasal KTP laser assisted dacryocystorhinostomy

BackgroundTo evaluate the clinical outcome of primary endonasal laser assisted dacryocystorhinostomy (ENL-DCR) using the potassium-titanyl-phosphate laser.MethodsWe retrospectively reviewed all primary ENL-DCRs performed within a period of twelve months by the same combined Ophthalmology and Otorhinolaringology team in Freeman Hospital, Newcastle upon Tyne, UK. The main outcome measure for success was resolution or significant improvement of epiphora. Details of surgery, intraoperative and postoperative complications, as well as pathology associated with failure were also studied. Patients were followed up for at least 12 months.ResultsA total of 41 consecutive ENL-DCRs on 29 patients (22 females, 7 males, mean age 75 years) were analysed. All patients had bicanalicular silicone intubation for at least 4 months. The success rate at 12 months postoperatively was 78.1%. Pathology associated with failure included: intranasal pathology (12.2%), mucocele (7.3%), and systemic sarcoidosis (2.4%). No significant intra-operative complications were recorded.ConclusionThe ENL-DCR with potassium-titanyl-phosphate laser can be considered as a safe and efficient primary procedure for the treatment of nasolacrimal duct obstruction.

Dacryocystorhinostomy in nasolacrimal duct obstruction secondary to sarcoidosis

Over the past 3 years we have treated 4 patients with nasolacrimal duct obstruction secondary to sarcoidosis. These patients have had mixed outcomes following endonasal laser-assisted dacryocystorhinostomy (DCR). A literature search from 1966 to the present yielded a further 11 cases of patients thought to have sarcoid who underwent DCR. The outcome of these 15 patients indicate that while all were initially successful, the subsequent failure rate is high. These patients are older than the majority of patients with sarcoidosis and there is a female preponderance. Systemic steroids reversed obstruction in one patient. We recommend nasal examination in all patients with nasal symptoms in whom DCR is proposed to help identify sarcoidosis or other intranasal disease and/or to allow treatment of specific diseases prior to surgery.

Results of Endonasal Laser-assisted Dacryocystorhinostomy

Endonasal laser-assisted dacryocystorhinostomy has been a subject of much interest since its introduction in 1990, offering the potential advantages of decreased postoperative morbidity and the lack of a cutaneous scar. In this study, the authors report the results of 46 endonasal laser-assisted dacryocystorhinostomy procedures performed on 42 patients between February 1991 and July 1992. The medical records of all patients undergoing endonasal laser-assisted dacryocystorhinostomy procedures were reviewed retrospectively in detail. Patients undergoing laser-assisted external dacryocystorhinostomies or conjunctivo-dacryocystorhinostomies and those with follow-up periods less than 4 months were not included in the study. A total of 46 endonasal laser-assisted dacryocystorhinostomy procedures were performed. Of these, 32 were successful and 14 failed after a single attempt, yielding a success rate of 70% (32/46). Of the 14 patients with failed procedures, 6 underwent a second endonasal laser-assisted dacryocystorhinostomy. Of these, five were successful. The success rate calculated on the basis of one or two attempts was 80% (37/46). The science and technology of endonasal laser-assisted dacryocystorhinostomy is undergoing a continuous process of evolution as a number of modifications are introduced, including better patient selection, more complete tissue removal at the osteotomy site, and the adjunctive use of mitomycin C. As this process continues, it is likely that the success rates in this modality will improve, making it an increasingly attractive alternative to external dacryocystorhinostomy.

Holmium: YAG Endonasal Laser Dacryocystorhinostomy

Previously described techniques of endonasal laser-assisted dacryocystorhinostomy appear to offer several advantages over conventional external dacryocystorhinostomy, including the following: (1) decreased disruption of medial canthal anatomy, (2) enhanced hemostasis, and (3) avoidance of a cutaneous scar. Although good results were achieved, several limitations of early laser-assisted techniques have been noted, including difficulty in removal of the thick bone of the anterior lacrimal crest and inability to obtain specimens of lacrimal sac mucosa for biopsy purposes. In a series of 40 consecutive, primary endonasal dacryocystorhinostomy procedures, we used the holmium:YAG (Ho:YAG) laser for bone removal and endoscopic sinus surgical instrumentation to obtain lacrimal sac biopsy specimens. Intraoperative hemostasis was excellent and medial canthal scarring was avoided in all patients. The overall long-term ostium patency rate in our series was 82%. Several technical modifications adopted in the latter part of our series, including use of a small drill for supplemental bone removal, extensive removal of lacrimal sac mucosa, and use of a double stent, appeared to enhance this success rate.

Endocanalicular laser-assisted dacryocystorhinostomy. An anatomic study.

In human cadaver specimens, a laser fiberoptic was advanced through the canalicular systems to create fistulas between the nasolacrimal sac and nose. A 400- to 600-microns, blunt-tipped quartz fiberoptic was then advanced through the upper and/or lower canaliculus to the medial aspect of the nasolacrimal sac. After 10 to 15 laser pulses (10 W for 0.1 second), a 2.5 x 2.5-mm fistula was created between the lacrimal sac and the nose just anterior and inferior to the middle turbinate. Additional laser pulses can further enlarge the fistula. Endocanalicular laser-assisted dacryocystorhinostomy has potential advantages compared with endonasal laser-assisted dacryocystorhinostomy, including the following: laser energy is directed away from the eye; the technique resembles standard nasolacrimal probing; and nasal endoscopy and instrumentation may prove unnecessary.