[Transcanalicular Laser Dacryocystorhinostomy: One-Year-Experience in the Treatment of Acquired Nasolacrimal Duct Obstructions].

Abstract

BACKGROUND:

External dacryocystorhinostomy (DCR) is at present the gold standard for the surgical treatment of acquired nasolacrimal duct obstructions, but tremendous progress has been made in recent years in improving minimally invasive techniques, sparing not only the skin, but also the medial lid structures, which contribute to the physiological palpebral-canalicular pump mechanism. The purpose of this study is to report our 1-year experience with the surgical technique, complications and results of transcanalicular laser assisted DCR.

PATIENTS AND METHODS:

48 consecutive transcanalicular laser-assisted DCRs combined with bicanalicular silicone intubation were performed for acquired nasolacrimal duct obstruction, and evaluated for intra- and postoperative complications, as well as subjective and objective success rates.

RESULTS:

Transcanalicular laser-assisted DCR combined with bicanalicular silicone intubation was surgically feasible in 45 cases (94 %). In 3 patients (6 %) it was impossible to position the aiming beam correctly at the anteroinferior rim of the middle turbinate using the superior canalicular approach, due to superior orbital rim prominence. Therefore 2 patients received no silicone intubation, despite a patent osteotomy at the back of the middle turbinate, and 1 patient underwent intraoperative conversion to external DCR due to anatomical narrowness of the nasal cavity. Perioperatively, 1 patient developed canalicular infection, 1 patient exhibited thermal injury to the canaliculus, and 4 patients exhibited premature prolapse of the silicone tube. At 6-months follow-up, functional success--defined as resolution of preoperative symptoms--was achieved in 35 of 45 surgically successful transcanalicular laser-assisted DCRs (78 %). Of the 10 postoperative failures (22 %), all patients reported epiphora, 6 patients were unable to irrigate the lacrimal drainage system, and 6 patients required surgical revision using external DCR.

CONCLUSIONS:

Transcanalicular laser assisted DCR is a promising minimally invasive approach for the surgical treatment of acquired nasolacrimal duct obstruction, in order to fill the gap between recanalising first step procedures and external DCR.

• Authors: K R Koch, C Cursiefen, L M Heindl
• Journal: Klinische Monatsblatter fur Augenheilkunde (Klin Monbl Augenheilkd) Vol. 233 Issue 2 Pg. 182-6 (Feb 2016) ISSN: 1439-3999 [Electronic] Germany
• Vernacular Title: Transkanalikuläre Laserdakryozystorhinostomie--1-Jahres-Erfahrung in der Behandlung infrasakkaler Tränenwegsstenosen.
• PMID: 26609674 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Georg Thieme Verlag KG Stuttgart · New York.

Chemical References

• Silicones

Topics

• Adult
• Aged
• Dacryocystorhinostomy (methods)
• Female
• Humans
• Intubation (methods)
• Lacrimal Duct Obstruction (diagnosis)
• Laser Therapy (methods)
• Longitudinal Studies
• Male
• Middle Aged
• Minimally Invasive Surgical Procedures (methods)
• Nasolacrimal Duct (diagnostic imaging, surgery)
• Silicones
• Treatment Outcome