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J.E. Hong, M.P. Hatton, A.M. Fay; Endocanalicular Nd:YAG Laser Dacryocystorhinostomy . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2421.
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Purpose: The use of a laser for dacryocystorhinostomy (DCR) was introduced by Massaro et al in 1990. Since then, a variety of lasers and techniques have been used for this purpose with varying success. The question of whether the laser DCR provides similar success rates to that of the external approach remains controversial. This study was undertaken to evaluate the efficacy of endocanalicular laser dacryocystorhinostomy. Methods: Retrospective chart review of 48 patients (37 women, 11 men) with nasolacrimal duct obstruction who underwent 54 endocanalicular laser DCRs performed by one surgeon between December 1997 and September 2002. Three patients had bilateral procedures and three patients had an additional revision procedure in the ipsilateral eye. The procedure involved the introduction of an Nd:YAG laser via the lacrimal punctum with creation of an ostium under intranasal endoscopic visualization. A silicone tube was placed and left for 3-6 months following the surgery to prevent occlusion of the ostomy site. The patients’ ages ranged from 22 to 88 years (mean 59 years) with one patient aged 7. Thirty-eight of the cases were performed for obstruction with epiphora only while the remainder of the cases were complicated by dacryocystitis or a history of trauma. Results: The success rate for endocanalicular laser DCR was 84% after one procedure and 88% following a revision DCR procedure. The follow-up period ranged from 3 months to 2 years. 8 of the initial 51 procedures (16%) were deemed failures based on the recurrence of epiphora and reflux on nasolacrimal irrigation. Of these cases, three underwent repeat laser DCR with two cases remaining patent at 4 months and 8 months following the second procedure. The third case showed re-stenosis of the site three months after the second procedure. An additional two of the failed cases required only one minor procedure each of balloon dacryoplasty and punctoplasty to obtain patency. There was a 96% overall success rate with only four additional minimally invasive procedures. No complications were seen. Conclusions: The success rate after endocanalicular laser DCR is slightly lower than after external DCR, but repeat procedures or other minimally invasive procedures such as balloon dacryoplasty and punctoplasty are not precluded by endocanalicular laser DCR and the addition of one such procedure increased the success rate to a comparable level of the external approach without the necessity of an external incision. Many patients elected to have this procedure where they had refused external DCR for years. Endocanalicular laser DCR offers a minimally invasive alternative to external DCR for nasolacrimal duct obstruction.
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