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Laser Dacryocystorhinostomy:
Part 1. Laser-Assisted Endonasal Endoscopic Dacryocystorhinostomy
Michael Mercandetti
Laser-assisted dacryocystorhinostomy (DCR) has been performed with argon, potassium titanyl phosphate (KTP), holmium:YAG, CO2, Nd:
YAG, erbium, and diode lasers. These lasers create the ostium from an intranasal, transcanalicular, or combined approach. In these approaches, microscopes, loupes, or endoscopes have been utilized.
Laser-assisted DCR was fi rst reported in the literature by Massaro and colleagues1 in 1990. This report involved one patient on whom the argon laser was used and the success rate was 100%. An operating microscope was used for intranasal visualization. Gonnering and col- leagues2 in 1992 described the use of the CO2 laser in conjunction with the endoscope. Fifteen patients were treated and the success rate was again 100%. Woog and colleagues3 had an 83% success rate in 40 patients with the use of the holmium:YAG laser. Of the 34 cases pre- sented by Metson and colleagues,4 seven patients had revision DCRs.
Table 22.1 shows the success rates of various reported studies perform- ing intranasal laser-assisted DCRs.
Some of the laser-assisted studies reported used adjunctive equip- ment or medication. In the study by Kong and colleagues,5 the drill and the radiofrequency unit were used in addition to the laser. In the study reported by Camara and Santiago,6 no mitomycin C was used. In the 2000 report by Camara and associates,7 mitomycin C was used.
Doyle and colleagues8 reported on a pediatric population of six patients and a 0% success rate.
As with all reports of success after DCR, the defi nition of success must be clearly delineated. Tripathi and colleagues9 reported a 91.3%
success rate in their series, but only 65.2% of the patients declared themselves cured.
Postoperative care is more involved with any endonasal and laser- assisted procedure than a conventional external DCR. The ostium must be examined and debrided as necessary. The low-intensity helium-
Chapter 22. Laser-Assisted Endonasal Endoscopic Dacryocystorhinostomy 237
neon laser10 has been reported to diminish healing time because of its antiinfl ammatory properties. The treatment was also noted to retard the propagation of granulation tissue.
The success rate of laser-assisted DCRs ranges from 0% to 100%.
Limitations of the procedure include damage to tissue surrounding the ostium from the heat generated by the laser. Additionally, the size of the ostium is limited because of the power of the laser. The expense of the equipment, training of personnel, and safety issues are also factors that must be considered in the use of the lasers. However, the ability to perform the surgery quickly, under local anesthesia, and with poten- tially less bleeding is appealing.
Acknowledgment. The author appreciates the work of Vickie Hase, who assisted in preparation of this chapter.
References
1. Massaro BM, Gonnering RS, Harris GJ. Endonasal laser dacryocystorhinos- tomy: a new approach to nasolacrimal duct obstruction. Arch Ophthalmol 1990;108(8):1172–1176.
2. Gonnering RS, Lyon DB, Fisher JC. Endoscopic laser-assisted lacrimal surgery. Am J Ophthalmol 1991;111(2):152–157.
3. Woog JJ, Metson R, Puliafi to CA. Holmium:YAG endonasal laser dacryo- cystorhinostomy. Am J Ophthalmol 1993;116(1):1–10.
4. Metson R, Woog JJ, Pulafi to CA. Endoscopic laser dacryocystorhinostomy.
Laryngoscope 1994;104(3 pt 1):269–274.
TABLE 22.1. Intranasal laser-assisted DCR success rates.
Author Year Laser Cases Rate of Success
Massaro et al. 1990 Argon 1 100
Gonnering et al. 1992 CO2:KTP 15 100
Woog et al. 1993 Holmium:YAG 40 83
Reifl er 1993 KTP 19 68
Metson et al. 1994 Holmium:YAG 34 82
Seppa et al. 1994 CO2/Nd:YAG 12 83
Kong et al. 1994 Holmium:YAG/Nd:YAG 92 77
Tutton and O’Donnell 1995 Nd:YAG 6 100
Sadiq et al. 1996 Holmiun:YAG 86 59
Mickelson et al. 1997 KTP 12 100
Szubin et al. 1999 Argon or Holium:YAG 28 96
Camara and Santiago 1999 Holmium:YAG 48 90
Camara et al. 2000 Holmium:YAG 123 99
Doyle et al. 2000 KTP 6 0
Caversaccio et al. 2001 Erbium:YAG 12 75
Piaton et al. 2002 Diode 363 92
Tripathi et al. 2002 Holmium:YAG 40 91
Moore et al. 2002 Holmium:YAG 33 71
Mirza et al. 2002 KTP 76 64
Liu et al. 2002 Semiconductor 7 86
Morgan et al. 2004 Holmium:YAG 9 67
238 M. Mercandetti
5. Kong YT, Kim TI, Kong BW. A report of 131 cases of endoscopic laser lac- rimal surgery. Ophthalmology 1994;101(11):1793–1800.
6. Camara JG, Santiago MD. Success rate of endoscopic laser-assisted dacryo- cystorhinostomy. Ophthalmology 1999;106(3):441–442.
7. Camara JG, Bengzon AU, Henson RD. The safety and effi cacy of mitomycin C in endonasal endoscopic laser-assisted dacryocystorhinostomy. Ophthal Plast Reconstr Surg 2000;16(2):114–118.
8. Doyle A, Russell J, O’Keefe M. Paediatric laser DCR. Acta Ophthalmol Scand 2000;78(2):204–205.
9. Tripathi A, Lesser TH, O’Donnell NP, White S. Local anaesthetic endonasal endoscopic laser dacryocystorhinostomy: analysis of patients’ acceptability and various factors affecting the success of this procedure. Eye 2002;
16(2):146–149.
10. Beloglazov VG, At’kova EL, Nurieva SM, Khvedelidze EP. Low-intensity helium-neon laser in the treatment of patients after endonasal dacryocys- torhinostomy. Vestn Oftalmol 2004;120(5):7–12.
