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Neel Kumar, David Lazar, Adham B al-Hariri; An alternative technique describing laser-assisted conjunctivodacryocystorhinostomy (CDCR) using the 532nm diode laser. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2778.
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Symptomatic epiphora secondary to bicanalicular obstruction is usually treated by performing a CDCR. Although good postoperative results are achieved with the traditional external approach, disadvantages include a permanent facial scar, prolonged healing time, and an increased procedure time. Our group began utilizing a less invasive, endoscopic laser-assisted approach for patients undergoing CDCR.
A retrospective chart review was performed for all patients with bicanalicular obstruction who underwent endoscopic, laser-assisted CDCR by a single surgeon over a 4-month period. A 14-gauge needle was externally introduced through the caruncle in the direction of the lacrimal bone until it came to a hard stop. A 532nm green diode laser was inserted through the large-bore needle. An endonasal endoscope was used to verify its correct location in relation to the middle turbinate. Photocoagulation of soft tissue and/or bone was performed creating an osteotomy. A trocar and serial gold dilators were used to expand the created fistula. A high-density porous polyethylene-coated glass tube was then inserted over a metal probe. The procedure was considered successful if the patient had subjective resolution of epiphora during the most recent follow up.
A total of 4 procedures were performed on 4 consecutive patients. The first case was performed as a revision CDCR, and the second patient had undergone and twice failed a dacryocystorhinostomy (DCR). The remaining 2 patients never had prior lacrimal surgery. All procedures were successfully performed without significant postoperative complications. Epiphora resolved in 100% of patients during the last postoperative visit with an average follow up period of 6 months. Our intraoperative time was reduced by up to 50% when compared to the standard CDCR approach. Intraoperative hemostasis required less effort. All patients appreciated the shorter recovery period and absence of a new external scar.
Endonasal endoscopic laser-assisted CDCR offers a modified surgical advance in revision and primary cases that is a safe, minimally invasive, and promising alternative to the traditional approach. The 532nm laser proved effective in both revising and creating the bypass fistula and nasal osteotomy. A larger cohort of patients and longer follow up is necessary to assess the long-term success of this technique.
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