Transcanalicular laser dacryocystorhinostomy using low energy 810 nm diode laser

Abstract

Background:Hypertrophic scarring may be a cause of failure after transcanalicular laser dacryocystorhinostomy (DCR) surgery. This hypertrophic scarring results from tissue charring and excessive coagulation, which may be caused by the high laser energy. We have evaluated the use of low energy settings to prevent hypertrophic scarring, for a successful outcome.Aims:To perform and evaluate transcanalicular laser DCR using low energy 810 nm diode laser.Design:Interventional, non-comparative, case series.Materials and Methods:Patients with nasolacrimal duct obstruction and chronic dacryocystitis, who needed DCR, and were fit for surgery under local anesthesia, were recruited to undergo transcanalicular laser DCR using a 810 nm diode laser. The outcome was measured by the patency of the lacrimal passage, as indicated by the relief in the symptoms and the patency on syringing at the last follow-up. The surgical time and surgical complications were noted.Statistical Analysis Used:Descriptive analysis.Results:The study included 94 patients. The average age was 30.1 years (range 15 - 69 years). Seventy (74.4%) patients were female. Eight patients had failed external DCR. Per-operative patency of the passage was obtained in all the patients. Average surgical time was seven minutes (5 – 18 minutes). At the end of the study period of one year, a successful outcome was seen in 85 patients (90.5%). There were eight patients of previous failed DCR surgeries, and six of them achieved a cure at the end of follow-up.Conclusions:Transcanalicular Laser DCR can be safely performed using a low power 810 nm diode laser. The surgery is elegant, minimally invasive, allows fast rehabilitation, and has an excellent success rate.

The Effectiveness of Postoperative Early Ostium Cleaning in Transcanalicular Diode Laser–Assisted Dacryocystorhinostomy

“…Success rates change from 47% (Dalez and Lemagne) to 97% (Szubin et al), and mean success rate was 78.7%. 3,4,7,8,[11][12][13][14]17,[22][23][24][25][26][27][28][29][30][31][32][33] Although our success rate is not higher than the rate of Szubin et al 32 study, it is higher than the other studies. This gives the authors the fact that cleaning the ostium increases the success rate of TDL-DCR.…”

Postoperative Changes in Olfactory Function After Transcanalicular Diode Laser Dacryocystorhinostomy

“…[9][10][11] However, reported complication rates are low and are usually related to problems with probing and intubation as in the external DCR. This effect is called photothermal effect and can cause tissue heating and charring, which could promote hypertrophic scarring and resultant shrinkage of the final osteum, or adhesion to the surrounding structures.…”

“…The mean surgical time was 12.5 minutes (range [8][9][10][11][12][13][14][15][16]. The fiber was inserted through the lower canaliculus until it reached the wall of the sac.…”

“…[2][3][4] In this approach, a probe is inserted through the lacrimal punctum via the canaliculus into the lacrimal sac following the anatomical pathway of tear outflow. [6][7][8][9][10] This procedure is a minimally invasive approach that has been shown to promote nasolacrimal patency. [4][5][6] Transcanalicular diode laser dacryocystorhinostomy (TCL-DCR) has been used much in recent years.…”

Surgical treatment of lacrimal duct obstruction – an overview

“…Pomimo starannie dobieranych parametrów lasera zawsze istnieje ryzyko urazów termicznych okolicznych tkanek i upośledzenia gojenia. Mankamentem techniki laserowej są również jej wysokie koszty (30,31).…”