A comparative study of modified transcanalicular diode laser dacryocystorhinostomy versus conventional transcanalicular diode laser dacryocystorhinostomy

Abstract

External dacryocystorhinostomy (DCR) is the gold standard surgical technique for the treatment of primary acquired nasolacrimal duct obstruction (PANDO). However, new techniques such as endoscopic DCR and transcanalicular dacryocystorhinostomy (T-DCR) are being studied in an attempt to reduce surgical time, avoid external scarring and preserve the lacrimal pump while achieving the same efficacy. The purpose of this study was to compare the efficacy between conventional T-DCR and modified transcanalicular dacryocystorhinostomy (MT-DCR) in patients with PANDO. MT-DCR is performed to remove nasal mucosa prior to laser osteotomy. This is a comparative, prospective, interventionist and randomized study. Patients with PANDO were selected to undergo MT-DCR or T-DCR by blocked randomization. PANDO was diagnosed based on clinical presentation, dye disappearance test and dacryocystography. All of the procedures were performed by the same surgery team members. Anatomical success outcome was defined as positive lacrimal syringing and functional success outcome was defined as the absence or improvement of epiphora. A total of 44 surgical procedures were performed (22 MT-DCR and 22 T-DCR). In the case of MT-DCR, the anatomical and functional success rates after 12 months were 90 and 86%, respectively. After T-DCR, these rates were 77 and 72%, respectively (p = 0.162). MT-DCR and T-DCR are both safe and fast procedures with low morbidity and well-tolerated.

Clinical characteristics and surgical treatment of dacryocystitis - a ten-year retrospective study

“…Greater incidence of DC on the left compared to the right side is a consequence of a sharper angle between the lacrimal sac and the nasolacrimal duct, therefore creating a greater possibility for the disruption of drainage, pathway, and a consequent infection, which is in correlation with the results of the study [7].…”

Fluorescein transit test time as a tool to assess lacrimal pump function after diode laser transcanalicular dacryocystorhinostomy and external dacryocysto-rhinostomy

“…As we know, the surgical success of this type of DCR is lower than that of EXT-DCR and endonasal DCR (20) ; however, some technical modifications have been incorporated into T-DCR in order to improve its success rate. These changes include early cleaning of the surgical ostium (21) , the use of the laser at a low energy output (22) , the creation of larger nasal ostium (14) , applications on patients older than 45 years (5) , the use of mitomycin C in the rhinostomy (23,24) and nasal mucosa blade excision prior to laser osteotomy to avoid thermal injury (25) .…”

Comparison of outcomes of conventional transcanalicular laser dacryocystorhinostomy and modified transcanalicular laser dacryocystorhinostomy.

“…In the present study, the average age of the patients was 52 years, which was similar in both groups, and the patients with nasal variations except for mild septum deviation during the endonasal examination were not evaluated. With laser DCR, DCR operation times have been significantly shortened, and surgical complications such as hemorrhage are less common [ 2 , 3 , 16 ]. In the present study, although the mean operation time of the group with nasal mucosal removal was longer compared to the conventional group, this difference was not clinically significant.…”

“…Along with photothermal damage caused by the laser, increased fibroblastic activity in the nasal mucosa [ 21 ], scar formation and narrowing in the ostium can be observed. In a recent study carried out by Feijó et al [ 16 ], they compared patients who underwent nasal mucosa excision prior to laser DCR and MMC after opening an osteotomy with patients who underwent conventional laser DCR. Although the anatomical and functional success rates in month 12 were higher in the first group, the difference was not statistically significant.…”