Transcanalicular Diode Laser-assisted Dacryocystorhinostomy Research Articles

Primary transcanalicular diode laser-assisted dacryocystorhinostomy: long-term success rates and risk factors for recurrence

ObjectiveThe aim of the study was to investigate the long-term success rates of transcanalicular endolaser dacryocystorhinostomy (TC-DCR) surgery along with the factors that possibly affect surgical success. MethodsPatients (n = 300) who underwent unilateral TC-DCR operations in the department of ophthalmology of our university hospital between January 2011 and June 2021 were included in the study. The subjects were divided into 2 groups, with group 1 showing no recurrence (n = 205) and group 2 showing recurrence (n = 95). ResultsThe mean follow-up period for the 300 patients was 26.7 ± 7.0 months (range, 11–33 months). The overall success rate was 205 of 300 (∼68%). Although, based on the univariate risk analysis, age, operative time, total laser power, tube removal time, septum deviation, fistulisation, and intraoperative hemorrhage were found to be risk factors, in multivariate risk analysis, only total laser power, septum deviation, and intraoperative bleeding were determined to be the main risk factors. ConclusionThe success rate of TC-DCR was lower than that of traditional external DCR, but because TC-DCR is a minimally invasive aesthetic surgery with a short operative time, it may become a preferred option by more ophthalmologists, especially for young patients without intranasal pathology and coagulation disorders and elderly patients at risk for general anaesthesia. It should be taken into account that the chances of success are relatively lower among patients with total laser power applied during surgery, intraoperative hemorrhage, fistulization, and septum deviation. In TC-DCR, bleeding control, short operative time, and low laser power are important to achieve a high success rate. Also, 1 year after TC-DCR, even the presence of anatomic drainage may lower the functional success of patients, so follow-up should be continued.

A Comparison of Transcanalicular, Endonasal, and External Dacryocystorhinostomy in Functional Epiphora: A Minimum Two-Year Follow-Up Study.

Purpose To compare the outcomes of transcanalicular diode laser-assisted dacryocystorhinostomy (TCL-DCR), nonendoscopic endonasal dacryocystorhinostomy (NEN-DCR), and external dacryocystorhinostomy (EXT-DCR) as first-line treatments for functional epiphora. Methods This multicenter, retrospective, case-control study included 135 eyes of 135 patients with functional epiphora (86 females and 49 males). Functional epiphora was diagnosed based on a patent lacrimal system with a delay in the fluorescein dye disappearance test (FDDT) or dacryoscintigraphy (DSG) and no ocular surface or eyelid abnormalities. The patients were treated with TCL-DCR (2008–2011) or Ext-DCR (2005–2008, 2011–2017) at Beyoglu Eye Research Hospital (Istanbul, Turkey) and NEN-DCR at Carrot Eye Surgery Clinic affiliated with the McMaster University (Hamilton, ON, Canada) (2010–2016). Success was defined as the absence of epiphora and the normalization of an earlier delayed FDDT after surgery. Results The TCL-DCR, NEN-DCR, and EXT-DCR groups consisted of 38, 47, and 50 eyes with 25.9, 44.2, and 45.9 months of follow-up. The success rate for TCL-DCR was 65.8%, 70.2% for NEN-DCR, and 84.0% for EXT-DCR. During the follow-up period, 13.2% of TCL-DCR cases and 6.4% of NEN-DCR cases developed an anatomic obstruction of the lacrimal system. Conclusion The EXT-DCR group had a higher success rate in the management of functional epiphora than the NEN-DCR and TCL-DCR groups and was significantly safer in terms of an iatrogenic anatomic block of the lacrimal system.

Transcanalicular Diode Laser-Assisted Dacryocystorhinostomy – Success Rates and Related Factors During 3 Years of Follow-Up

ABSTRACT Purpose: To evaluate the success rates of transcanalicular diode laser-assisted dacryocystorhinostomy (TCL-DCR) during 3 years of follow-up and to find clinical factors that influence surgical outcomes. Methods: Major outcomes were the anatomical success defined as a patent neo-ostium tested by irrigation and the functional success defined as a patent osteotomy with the absence of epiphora, accessed at 6-month, 1, 2, and 3-year follow-up visits. To determine which factors influence success rates, patients were divided according to gender, age, previous lacrimal surgeries, nasosinusal anatomy, energy employed, treatment with topical prostaglandin analogs, and timing of extubation. Results: A total of 134 eyes were included. 55.2% of patients underwent peribulbar block. The surgical mean duration was 30.6 min. We obtained anatomical and functional success rates of 80.0% and 70.8% at 6 months; 69.3% and 61.4% at 1 year; 64.2% and 58.0% at 2 years; 56.4% and 46.2% at 3 years, respectively. Functional success was significantly higher in younger patients (p = .008). Bicanalicular intubation for 2 months improved anatomical and functional success rates (p = .028 and p = .001, respectively). No other factors showed a significant impact. 85.8% of patients didn´t experience any complications. Palpebral swelling was the most frequent complication. Conclusion: TCL-DCR is a minimally invasive, repeatable, and safe alternative to treat nasolacrimal duct obstructions. We found success rates comparable to literature and stated that younger patients and those intubated for 2 months show better results.

Anatomical and functional outcomes of transcanalicular diode laser assisted dacryocystorhinostomy as a primary procedure

Summary Introduction The goal of this study was to assess the efficacy of transcanalicular diode laser assisted dacryocystorhinostomy (TDL-DCR) for the treatment of primary acquired nasolacrimal duct obstruction. Material and methods This was a single center retrospective study. We included all patients who underwent TDL-DCR between July 2015 and October 2017 for chronic epiphora or chronic dacryocystitis. All procedures were performed under local anesthesia with sedation. The anatomical and functional success rates were studied as a function of each operative indication. Results Thirty-seven patients were included (18 had chronic epiphora and 19 had chronic dacryocystitis). All but one patient had bicanalicular silicone stent intubation . Irrigation of the lacrimal system demonstrated postoperative patency in 78% of patients operated for chronic epiphora and 76% of those with chronic dacryocystitis. The functional success of the surgery (as defined by the Munk score) was higher if the operative indication was chronic dacryocystitis (62%) (whereas it was only 41% for the indication of chronic epiphora). Conclusion TDL-DCR has a lower anatomical and functional success rate than those reported in the literature for external or endonasal dacryocystorhinostomy. However, it retains a place in the treatment of primary acquired nasolacrimal duct obstruction (in particular when it is complicated by chronic dacryocystitis), especially if there is an absolute or relative contraindication to the two other dacryocystorhinostomy techniques.

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

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.

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction.

Today's gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), a relatively invasive procedure that can be performed after failure of recanalizing treatments. However, with progress in the field of diode laser technology, new approaches have emerged. Laser-assisted transcanalicular DCR with subsequent bicanalicular silicon intubation is a new option showing great promise as a viable minimally invasive procedure. Under permanent endoscopic visual control from the nasal cavity, a diode laser fiber is inserted into the lacrimal sac and laser energy is applied to create a bony ostium between the lacrimal sac and the nasal cavity. Since no skin incision needs to be made, advantages of this method comprise the sparing of the skin as well as the medial palpebral structures and the physiological palpebral-canalicular pump mechanism. The duration of surgery as well as reconvalescence is generally shorter than with external DCR. Complications include silicon tube prolapse, mild swelling and, rarely, canalicular infection and thermal injury. One-year functional success rates, defined as complete resolution of symptoms and ostium patency, are high, yet still range behind those of external DCR. However, secondary external DCR after failure of laser-assisted DCR can be performed without difficulty. Thus, laser-assisted transcanalicular DCR is a valid option that should be considered as a second-step procedure after failure of recanalization procedures and before external DCR.

Anatomical variants and bilateral lacrimal pathways surgery: avoiding unnecessary surgery.

Success rates (SR) of transcanalicular diode laser-assisted dacryocystorhinostomy (TCL DCR) may be affected by the presence of nasal anatomical variations and additionally by whether or not the pathology is bilateral. The aim is to determine whether it is necessary to perform preliminary nasal anatomical variations surgery and to determine whether bilateral cases may be operated simultaneously. We extracted the patients undergoing simultaneous bilateral TCL DCR and we compared SR across the different groups using ANOVA, Chi-square testing and logistical regression.159 Lacrimal pathways were operated: 89 unilateral and 35 bilateral. Non-nasal anatomical variations (non-NAV) unilateral surgery returned a success of 72.72%. The mean SR for nasal anatomical variations (NAV) unilateral surgery was 70.1%. The SR for non-NAV bilateral surgery was 60.86%. The mean SR for nasal anatomical variations bilateral surgery was 58.33%. As we identified no significant differences in the SR for NAV and non-NAV patients, we can avoid simultaneous corrective surgery.

En Az İki Başarısız Eksternal Dakriyosistorinostomi Geçirmiş Hastalarda Diod Lazer Yardımlı Transkanaliküler Dakriyosistorinostominin Etkinliği: İki Yıllık Sonuçlar

En Az İki Başarısız Eksternal Dakriyosistorinostomi Geçirmiş Hastalarda Diod Lazer Yardımlı Transkanaliküler Dakriyosistorinostominin Etkinliği: İki Yıllık Sonuçlar

PREPOZNAVA IN ZDRAVLJENJE SOLZNEGA OČESA

Background: Watering eye is in the population a very common eye phenomenon. Watering eye is presented with excessive amount of tears on the surface of the eye that are spilled over the edge of the eyelid on the skin of the eyelids and face. Basically, watering eye is divided into excessive tearing or lacrimation and on the lack of drainage of tears or epiphora. Only correct identification of both phenomena can lead to successful treatment of several patients.Methods: The article presents the anatomy and physiology of lacrimal system causes for lacrimation and epiphora, diagnostic tests and types of treatment. Laser treatment method for epiphora which is performed at the Eye Hospital in Ljubljana is presented.Results: The most common cause for epiphora is nasolacrimal duct occlusion, which is treated by dacryocystorhinostomy. With the minimally invasive version of this treatment method, transcanalicular laser dacryocystorhinostomy, we are able to treat epiphora in 85% of cases.Conclusions: Proper diagnosis and treatment of watering eye is important because of the impact of tearing on a number of eye processes. Incorrectly identified causes and treatment deteriorate patients' quality of life with decreased visual acuity and disrupted social contacts. In the article we show the contribution of the Eye Hospital in Ljubljana to the successful treatment of epiphora with transcanalicular diode laser-assisted dacryocystorhinostomy.

Influence of Septal Deviation on the Prognosis of Transcanalicular Diode Laser-Assisted Dacryocystorhinostomy.

Purpose. The objective of the present study is to determine whether the success rate in transcanalicular diode laser-assisted dacryocystorhinostomy (TCL DCR) is influenced by the variant septal deviation (SD). Methods. Patients were divided into two groups: one including operated lacrimal pathways (LP) with no anatomical nasosinusal variants and the other group of LP with SD. This study began on January 1, 2008, and ended on December 31, 2010, at Morales Meseguer Hospital. Variables were compared by means of ANOVA and a logistic regression model (LOGIT). Results. Out of the 159 LP operated on, 102 had no nasosinusal anatomic variant, but 39 LP were associated with SD. The first group evidenced a success rate of 67.64%, while the second group evidenced a success rate of 66.7%. Conclusion. We found no significant statistical differences between the success rates in the two groups (with SD and no anatomical variants). So we could avoid previous or concomitant septoplasty in some cases (mild and moderate SD).

Measuring The Impact Of Innovations On Efficiency In Complex Hospital Settings

Abstract In this paper the authors propose an approach for measuring the impact of innovations on hospital efficiency. The suggested methodology can be applied to any type of innovation, including technology-based innovations, as well as consumer-focused and business model innovations. The authors apply the proposed approach to measure the impact of transcanalicular diode laser-assisted dacryocystorhinostomy (DCR), i.e. an innovation introduced in the surgical procedure for treating a tear duct blockage, on the efficiency of general hospitals in Slovenia. They demonstrate that the impact of an innovation on hospital efficiency depends not only on the features of the studied innovation but also on the characteristics of hospitals adopting the innovation and their external environment represented by a set of comparable hospitals.

Diode laser-assisted transcanalicular dacryocystorhinostomy: the effect of age on the results.

The aim of this study was to explore the effect of age on the success of transcanalicular diode laser-assisted dacryocystorhinostomy (TCDCR). Seventy patients (70 eyes) who underwent transcanalicular diode laser-assisted dacryocystorhinostomy for the treatment of nasolacrimal duct obstruction as a primary surgery were included in this retrospective, nonrandomized study. The patients were divided into two groups according to age. Mean ages were 21.3 ± 3.3 in group 1 and 60.3 ± 7.3 in group 2. The records of the 3-, 6-, and 12-month follow-up examinations were evaluated, and the anatomical and functional outcomes were noted. Functional success was defined as the absence of epiphora as indicated by the patient. Anatomical success was determined as patency of the neo-ostium with irrigation. At the 3-month follow-up, 67% cases in group 1 showed anatomical success and 52% showed functional success; in group 2, the rates were 100% and 92%, respectively. Functional and anatomical success rates were the same for both the 6- and 12-month visits; 46% in group 1 and 76% in group 2. The results in group 2 were significantly better at all three follow-up visits (p<0.05). This study clearly showed that the older patients experienced better transcanalicular diode laser-assisted dacryocystorhinostomy results than the younger patients. The diminished inflammatory response in the older population may be a possible contributing factor to these results.

The effectiveness of postoperative early ostium cleaning in transcanalicular diode laser-assisted dacryocystorhinostomy.

To search the effectiveness of postoperative first week ostium cleaning in transcanalicular diode laser-assisted dacryocystorhinostomy (TDL-DCR). A total of 123 eyes of 123 patients with acquired dacryostenosis who had surgery were retrospectively evaluated. Diode laser was used in all patients. All patients were operated under local anesthesia by a single surgeon. Intranasal endoscopic cleaning of the ostium by surgical suction under local anesthesia was performed as an extra job in the postoperative first week visit. Mean age of the patients was 55 (range, 41-78 years) years. Mean follow up was 13.4 months. Successful outcomes were achieved in 117 of 123 (95.1%) patients. Reoperation was performed in 6 patients with restenosis and were free of symptoms in 1-year follow up. Postoperative first week cleaning of the nasal ostium by surgical suction with the aiding of nasal endoscopy is a very effective method increasing the success rate of TDL-DCR.

Transcanalicular Diode Laser Assisted Dacryocystorhinostomy in Primary Acquired Nasolacrimal Duct Obstruction

To evaluate the success rate of 980 nm transcanalicular diode laser-assisted dacryocystorhinostomy (TDL-DCR) in patients with primary acquired nasolacrimal duct obstruction (PANDO) and to consider the time and the reasons of failure. Hundred and thirty eyes of 125 patients who underwent of TDL-DCR for the treatment of PANDO are included in this retrospective, noncomparative, nonrandomized, interventional study. The mean follow-up time was 24.29 months (range 8-34 months). Functional success was described as disappearance of epiphora and presence of a patent ostium on lacrimal irrigation. Anatomical success was described as a patent ostium to irrigation but continuing epiphora. Patients with persistent epiphora and a closed ostium were classified as a surgical failure. At third month follow up, 85.4% of cases had complete resolution of their symptoms. The functional success rate decreased to 67.7% at 6 months, to 63.3% at first year, and to 60.3% at second year, while the patency of the lacrimal drainage system was restored in 93.1%, 74.6%, 69.5%, and 68.2% of the cases, respectively. The average total amount of delivered laser energy was 1322.7 J. No correlation could be found between the age of the patient, delivered laser energy, and the surgical success (p = 0.38, p = 0.62). Transcanalicular diode laser-assisted DCR is a fast and relatively easy alternative surgical method, which avoids a facial skin scar, to treat PANDO. The functional success rate is higher in the first months but decreases to low 60 %'s at the end of first year and remains the same at the second-year follow up.