Purchase this article with an account.
Scott M. McClintic, Michael K. Yoon, Maziar Bidar, Robert C. Kersten; Tissue Necrosis Following Diode Laser-Assisted Transcanalicular Dacryocystorhinostomy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1461.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Advantages of transcanalicular laser-assisted dacryocystorhinostomy (TCDCR) over conventional external DCR have been purported to include decreased operating time, reduced morbidity, enhanced cosmesis, and a shorter recovery time. However, one case of full-thickness tissue necrosis has recently been reported to have occurred following TCDCR. We now report two additional cases of full-thickness tissue necrosis following TCDCR.
Two cases of full-thickness tissue necrosis following diode laser-assisted TCDCR were referred from the same outside practice to the Ophthalmic Plastic Surgery service at UCSF during a two month period in early 2011.
An 81 year old female with a history of left nasolacrimal duct obstruction (NLDO) status-post TCDCR with topical mitomycin C presented with full-thickness tissue necrosis over the left medial canthus. The defect was repaired with a glabellar flap, and there was breakdown of the flap in the weeks following her repair. A 63 year old female with a history of left involutional NLDO status-post TCDCR presented with full-thickness tissue necrosis over the left medial canthus. Despite two separate attempts at repair, the patient continued to experience breakdown at the site of the original defect. Neither patient’s defect was fully healed at the time of their most recent evaluation.During the initial repair of patient #2, multiple bony erosions were observed in the frontal process of the maxilla, which appeared consistent with laser damage. The bone in this area is considerably thicker than the adjacent lacrimal bone, and we hypothesize that anterior orientation of the diode laser probe tip against the frontal process of the maxilla prompted the application of greater amounts of laser energy in an attempt to create an osteotomy. The high quantities of laser energy may have caused local tissue damage sufficient to impair the normal wound-healing process and lead to the eventual necrosis of the affected tissue.
Full-thickness tissue necrosis is a potential complication following TCDCR, and these defects may be refractory to reconstructive repair.
This PDF is available to Subscribers Only