Transcanalicular Laser-assisted Dacryocystorhinostomy Research Articles

Comparison of Outcomes of External Dacryocystorhinostomy and Transcanalicular Laser-Assisted Dacryocystorhinostomy in Patients with Primary Acquired Nasolacrimal Duct Obstruction.

This study aimed to compare anatomical and functional outcomes of external dacryocystorhinostomy (EX-DCR) and transcanalicular multidiode laser dacryocystorhinostomy (TDL-DCR) in patients with primary acquired nasolacrimal duct obstruction (PANDO). This study was conducted on 60 eyes of 60 patients with PANDO. The study subjects were randomly divided into two groups. Group 1 included 30 patients who underwent EX-DCR, and group 2 included 30 patients who underwent TDL-DCR. Surgery success rates were determined by patency of the neo-ostium, with free saline flow on irrigation and the absence of epiphora. There were 23 women (76.7%) and 7 men (23.3%) with a mean age of 47.33 ± 12.44 years in group 1, and 18women (60%) and 12 men (40%) with a mean age of 46.2 ± 19.4 years in group 2. There was no significant difference between groups 1 and 2 with respect to age or gender (p = 0.801, p = 0.267, respectively). The mean duration of symptoms was 3.2 years, ranging from 1.5 to 5 years. The mean postoperative follow-up was 12.3 ± 2.44 months. At the end of the follow-up period, the surgery success rates were 96.7% (29/30 eyes) in group 1, and 90% (27/30 eyes) in group 2. There was no statistical difference in the surgery success rates between groups (p = 0.612). TDL-DCR is a minimally invasive and safe procedure. The lack of bleeding and incision scar and shorter operation time suggest that TDL-DCR can be a good alternative in PANDO patients.

Transcanalicular laser dacryocystorhinostomy for acquired nasolacrimal duct obstruction: an audit of 104 patients

PurposeExternal dacryocystorhinostomy (DCR) is considered as the gold standard in the treatment of acquired nasolacrimal duct obstruction. However, many advances have been made towards the development of modern minimally invasive therapies. These new techniques were proven less harmful to the patients’ skin and medial palpebral structures with their palpebral-canalicular pump mechanism. Options include endonasal and transcanalicular procedures. Here, we report on our 2-year experience with the surgical technique, results and complications of transcanalicular laser-assisted DCR.MethodsThis is a retrospective study. A total of 104 patients with acquired nasolacrimal duct obstruction underwent transcanalicular laser-assisted DCR combined with bicanalicular silicon intubation. We then analyzed intra-/post-operative complications and subjective and objective success rates. The institutional ethics committee ruled that approval was not necessary. The trial was registered with the German Clinical Trials Register (DRKS00012879).ResultsTranscanalicular laser-assisted DCR in combination with bicanalicular silicon intubation could be performed surgically successfully in 101 patients (97%). In three cases (3%) using the superior canalicular approach, positioning of the laser instrument at the anteroinferior rim of the middle turbinate failed. Complications included thermal injury to the canaliculus (one), canalicular infection (two) and silicon tube prolapse (ten). Functional success (resolution of preoperative symptoms) was achieved in 80 cases (77%), functional failure occured in 24 cases with all patients reporting persisting epiphora, 15 reporting failure to irrigate the nasolacrimal duct and 15 requiring secondary external DCR.ConclusionsLaser-assisted DCR shows promising results with few complications. It seems well suited as a second-step procedure after failed recanalization and before external DCR.

Laser-assisted dacryocystorhinostomy in nasolacrimal duct obstruction: 5-year follow-up.

To evaluate the long-term sucess rate of laser-assisted dacryocystorhinostomy (L-DCR) in patients with nasolacrimal duct obstruction (NDO). Forty-one eyes of forty patients aged between 21-85y (mean 56.7y) who underwent L-DCR for the treatment of NDO were included in this retrospective, non-randomized study. The follow-up time was 72mo. Functional sucess was defined as the disappearance of epiphora under normal conditions and the presence of a patent ostium on lacrimal irrigation. Anatomical success was defined as a patent lacrimal passage on syringing besides continuing epiphora. Surgical failure was defined as persistent epiphora and closed ostium. Twenty-seven of 40 patients (67.5%) were female and 13 of 40 patients (32.5%) were male. The NDO was right-sided in 17 (42.5%) patients and left-sided in 22 (55%) patients whereas 1 (2.5%) patient had undergone bilateral surgery. In 11 (27.5%) patients there were additional nasal abnormalities requiring simultaneous surgical approach. The average time for L-DCR was 26.50±4.9min (16-39min) and the average total amount of laser energy used was 287±27.9 J (239-367 J). At the 5y follow-up, anatomical sucess rate was 75.0% (30 patients) and functional success rate was 65.0% (26 patients), whereas surgical failure was seen in 25% (10 patients). Revision of surgery was performed in 10 cases (25.0%); failure of revision surgery was seen in 2 cases (5.0%). Transcanalicular L-DCR is a reliable and fast procedure in the treatment of NDO. It can be alternative to external DCR which is accepted as the gold standard currently. The functional and anatomical success rate is higher in the first months and years, but still satisfactory at fifth year.

Transcanalicular Laser-Assisted Dacryocystorhinostomy With Endonasal Augmentation in Primary Nasolacrimal Duct Obstruction: Our Experience.

To evaluate and compare the success rate of transcanalicular laser-assisted dacryocystorhinostomy with endonasal augmentation, with and without intubation, in patients suffering from primary acquired nasolacrimal duct obstruction, at 1 year of follow up. A prospective, randomized interventional pilot study was conducted at a tertiary care center, in accordance with the guidelines of Declaration of Helsinki. Sixty eyes of 60 adult patients with primary acquired nasolacrimal duct obstruction were included. The participants were divided randomly into 2 equal groups (A and B-without and with bicanalicular intubation, respectively). An osteotomy was first created using 980 nm diode laser (set at 8W continuous mode) transcanalicularly and then enlarged intranasally using Blakesley's nasal forceps, followed by bicanalicular silicon intubation in group B patients. The tubes were removed at the end of 8 weeks. The ostium size was assessed endoscopically at 8 weeks and again at the end of follow up, at 1 year. A successful outcome was defined in terms of ostium patency at the end of 1 year. The results were analyzed at the end of a follow up of 1 year, using various statistical tests (p < 0.05). The mean age of the patients was 35.3 ± 15.89 years, with 23 male and 37 female patients, the 2 groups having a similar male:female ratio. An overall success rate of 90% was achieved at the end of 1 year with no statistically significant difference between the groups. Postoperative complications like tube displacement and punctal, canalicular injury were more in the intubated group. The average osteotomy size was 8.06 ± 5.4 mm at the end of 1 year. Transcanalicular laser-assisted dacryocysto rhinostomy, with endonasal augmentation, is a scarless, effective, daycare procedure, for treatment of primary acquired nasolacrimal duct obstruction with no additional advantage offered by silicone intubation.

Study of microbial growth on silicone tubes after transcanalicular laser-assisted dacryocystorhinostomy and correlation with patency.

Intubation in primary transcanalicular laser assisted dacryocystorhinostomy (TCLADCR) is performed to increase the success rates. However, the associated inflammation and infection can have adverse effects. To study the microbial infection and drug susceptibility of extubated silicone tubes and final anatomical patency in patients undergoing TCLADCR. A non-randomised prospective interventional study was conducted in a tertiary care eye centre. The study included twenty consecutive adult patients with primary nasolacrimal duct obstruction. They underwent TCLADCR with bicanalicular silicone intubation. The stents were removed at 2 months and subjected to culture sensitivity, followed by administration of appropriate antimicrobial agents. Main outcome measures studied were the microbial spectrum on the cultured tubes, their sensitivity profile and its correlation with final anatomical patency. A positive culture was obtained in 100% cases, comprising of normal commensals and pathogenic organisms. Of the total 24 isolates, 16 (66.6%) Gram positive bacteria (75% Staphylococcus aureus) and 8 (33.3%) Gram negative bacteria (commonest E.coli) were found, with 4 tubes having more than one isolate. No fungal growth was seen. Ninety percent success rate was achieved at one year following appropriate antimicrobial therapy except in 2 patients with gram negative isolates who had failed to take the prescribed antibiotics following sensitivity reports. There was no correlation between multiple infections and success rate. However, by using the Fisher exact test, a positive correlation was obtained between appropriate antibiotic treatment and the final anatomical patency (p less than 0.05). Silicone intubation predisposes to microbial growth, which if neglected, can lead to failure of TCLADCR.

Conventional dacryocystorhinostomy in a failed Trans-canalicular laser-assisted dacryocystorhinostomy

Sir, We would like to congratulate the authors about their study. However, we have some concerns and comments about the study. 1. Considering the data of the study, the success rate of transcanalicular laser-assisted dacryocystorhinostomy TCLA-DCR) surgery in this issue is fairly low. Recent studies have shown that the success rates of classical DCR surgery and endonasal surgery were 90–95% and 70–80%, respectively.[1] On the other hand, the success rate of early (3 months) and late results of TCLA-DCR were published as 64–90% and 87.5–90%, respectively.[2] Although these data show the superiority of the success rate of classical DCR surgery, some studies, on the contrary, reported more successful results with endonasal DCR surgery. Hartikainen et al., found the results of endonasal DCR surgery more successful than the ones with classical DCR.[3] In a study with large case series with 244 patients, Linberg et al., found the success rates of external DCR and endonasal DCR as 92.6% and 93.4%, respectively, with 18 months follow-up.[4] This result was explained by lachrymal pump dysfunction, with the injury of medial chantal anatomy in external DCR. Plaza et al., reported their TCLA-DCR surgery success rate as 88% with 36 months follow-up. Narioka and Ohashi reported the success rate as 80% with TCLA-DCR of the patients who had undergone failed external DCR surgery.[5] 2. The success rate of the results of laser-assisted DCR surgery in this article was reported with a considerably low rate (44%). This is the lowest success rate reported in the literature. This result might be due to improper patient selection or inadequate surgical procedure. In this article, previous data about the TCLA-DCR surgery was not mentioned. Three patients reported with fistulous tract over the sac area (9%) before external DCR surgery in the article. Knowing the fact that these fistulas also existed before TCLA-DCR surgery, it can be considered that patient selection of the study should be overviewed. The most important factor that affects the success of TCLA-DCR surgery is the size and location of osteotomy. However, according to some authors, wound healing and tissue response affects the survival of the fistula without dependence of osteotomy size. Granulation tissue due to laser and silicone tube in the early period and formation of fibrosis in the late period causes the obstruction. In addition, presurgical anatomic defect or postsurgical trauma and infection may cause secondary obstruction. Therefore, using mitomycine or silicone stent for fistula maintenance has been used as an adjunctive for this surgery. Also, for high success rates of TCLA-DCR surgery, resection of granulation tissue and opening synechias is efficacious. 3. Is it preferable to perform classical DCR surgery after a failed TCLA-DCR surgery? With the aid of a flexible microendoscope, direct visualization of pathologic changes in the lachrymal passages makes it possible to detect the localization and identify the reason of obstruction instantly and facilitate the management of these pathologic changes. This secondary attempt after TCLA-DCR surgery is more easy and comfortable than external DCR surgery.

Conventional dacryocystorhinostomy in a failed Trans-canalicular laser-assisted dacryocystorhinostomy

We report the success rate and problems associated with conventional dacryocystorhinostomy (DCR) in failed cases of Trans-canalicular, laser-assisted DCR (TCLADCR). Out of 50 patients operated by the TCLADCR technique during the period 2005 – 2006, 33 patients had failure, which was confirmed on syringing of the nasolacrimal passage. Before considering them for conventional DCR, a thorough ear, nose, throat (ENT) examination was done by an ENT surgeon, to rule out a nasal pathology. All the patients were operated by the conventional standard DCR method at a medical college. While performing the surgery, the problems that came across were identified and noted. The success rate was found to be 91% in this study in a follow-up period of one year, with no major intra-operative problems. Conventional DCR is still a gold standard and should be considered as a procedure of choice in failed cases of TCLDCR.

Dacriocistorrinostomia transcanalicular com laser diodo: resultados preliminares

To describe the technique and initial results of laser-assisted dacryocystorhinostomy performed through the canaliculi. Ten patients with nasolacrimal duct obstruction underwent transcanalicular laser-assisted dacryocystorhinostomy. A silicone tube was inserted through the canaliculi and the ostium into the nasal cavity where it will be kept for 6 months. All ten operations were performed without negative occurrences. One patient presented displacement of the silicone tube one day after surgery. Nine of the ten patients reported disappearance of epiphora at the end of the first week following surgery. During the first month, one of these patients presented with epiphora due to obstruction of the lacrimal-nasal fistula and another lost the silicone tube in the first month following surgery. Transcanalicular laser-assisted dacryocystorhinostomy is a potentially useful method to perform dacryocystorhinostomy.

Transcanalicular Laser-Assisted Dacryocystorhinostomy

Current techniques of laser-assisted dacryocystorhinostomy are mostly endonasal. In this report, the authors describe their technique of laser-assisted dacryocystorhinostomy performed through the canaliculi and the surgical results they achieved. Fourteen patients with nasolacrimal duct obstruction underwent transcanalicular laser-assisted dacryocystorhinostomy. The bony ostium was perforated using a fiber optic-transmitting, giant-pulse Nd:YAG laser, with an energy of 0.5 to 4 J per pulse. The total energy used to create an ostium was 18 to 34 J. A silicone tube was inserted through the canaliculi and the ostium into the nasal cavity and kept in place for 5 to 7 months. Patients were observed for 18 to 22 months. Nine of the 14 patients (64%) reported the disappearance of epiphora following surgery. In 3 patients, no relief of epiphora was obtained. In 1 patient the operation was not completed because of severe nasal bleeding. In another, tearing began 12 months after surgery (6 months after tube removal). Transcanalicular laser-assisted dacryocystorhinostomy is a potentially useful method for performing dacryocystorhinostomy. Technical modifications and improvements are needed to increase the success rate.

Endoscopic surgery for lacrimal and orbital disease

Recent interest in the application of endoscopic surgical techniques to the field of ophthalmic plastic and reconstructive surgery has occurred primarily in the areas of lacrimal and orbital disease. Examples of important innovations include endoscopic intranasal laser-assisted dacryocystorhinostomy (DCR), transcanalicular laser-assisted DCR, microendoscopy of the lacrimal drainage system, endoscopic orbital decompression, orbital endoscopy, and computer-assisted surgery. The evolution of these exciting and promising innovations is reviewed with emphasis on the need for continued critical evaluation of these techniques by rigorous clinical research prior to forming specific recommendations for their widespread general use.