Endoscopic holmium:YAG laser dacryocystorhinostomy

Abstract

SUMMARYThe early results of the first 50 primary endonasal laser dacryocystorhinostomies in 49 patients performed with the holmium:YAG laser are presented. Overall, 35 (70%) were successful in relieving symptoms of naso lacrimal obstruction after a mean follow-up period of 4 months. This improved to 79% in the subgroup of patients who underwent intubation of the naso-Iacrimal system. These results were similar to the results of a retrospective study of 67 patients undergoing conven tional dacryocystorhinostomy in our unit. Conventional surgery was performed under general anaesthesia in all but 1 case and all were treated as inpatients, with a mean hospital stay of 2.3 days, whereas all but 1 of the laser group had their surgery under local anaesthesia and 46 operations (94%) were performed as an outpatient procedure. Surgery was significantly quicker with the endonasal laser technique and 90% of patients questioned found this technique to be entirely accep METHODS Endoscopic Laser DCRConsecutive patients who required primary drainage surgery to relieve naso-Iacrimal obstruction (as evidenced by epiphora, mucocoele or a history of acute dacryocystitis) between July 1993 and March 1994 were recruited to this study. All patients gave written consent to the procedure. Pre-operatively, a history was taken and a routine ophthalmic exam ination was performed. Probing and syringing of the naso-Iacrimal system was performed and patients with common canalicular occlusion excluded.Age, sex and indications for surgery were noted. The light was directly visualised endonasally with a 0° nasal endoscope. The laser energy was delivered via a 15° probe, aimed at the light. For mucosal ablation, the laser was set at a pulse energy of 0.6 J with a frequency of 10 Hz. When bone was reached, the energy was increased to 1.0 J (at the same frequency) and was used to vaporise the bone. Once an ostium had been created, indicated by passage of the light probe into the nasal cavity, it was enlarged until easy Eye (1996) The average amount of local anaesthetic used was 5.9 ml. The mean operative time was 20.9 (14.8) minutes and the mean energy employed was 0.64 kJ. Per-operative complications occurred in 13 (26%) procedures; 10 of these were related to technical difficulties. Two patients suffered a transient medial rectus palsy as a result of the LA and 1 patient Twenty-eight procedures (56%) employed tubes and 22 (44 %) did not. There were no significant differences between these two subgroups for all analyses, apart from a higher volume of LA being used in the former (6.4 (1.6) versus 5.3 (1.0) ml respectively, p<0.05). However, more procedures with tubes were successful compared with those without (22 (79%) compared with 13 (59%) respectively), although the difference did not achieve statistical significance. Both subgroups had a similar duration of follow-up (4.0 (1.1) versus 4.1 (2.0) months, respectively). RESULTS Endoscopic Laser DCR Conventional DCROver the 2 year study period, 67 patients underwent conventional DCR. There w...

A consideration of the time taken to do dacryo-cystorhinostomy (DCR) surgery

“…2 EEL-DCR is often performed as day-case surgery under local anaesthesia using the holmium:YAG or the KTP laser. 3,5,7,11,16 Advantages of EEL-DCR over EES-DCR include even less blood loss during surgery and shorter operating time. These advantages make EEL-DCR suitable, for example, for the frail elderly patient, who otherwise might not be fit for longer lacrimal surgery, either under local or under general anaesthesia.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The perceived disadvantages of the highly successful external approach dacryocystorhinostomy (DCR) [17][18][19][20][21] include the risk of cutaneous scar and lengthy surgery with significant blood loss. These reservations have fuelled the popularity of minimally invasive endonasal approaches.…”

“…In particular, the use of the holmium:YAG laser has increased the throughput of lacrimal surgery for many units. 11 However, success rates for both endoscopic endonasal surgical (EES) 4,6,10,16 and laser (EEL) 5,7,8,11,12,14,16 types of DCR are generally lower than for external DCR, 9,[18][19][20][21] resulting in more cases that will require secondary surgery.…”

Paediatric laser DCR

“…This was statistically significant. Sadiq et al (1996) have also shown a higher success rate of ELDCR with intubation (79%) versus no intubation (59%) although these results did not reach statistical significance. In their medium term follow-up study (1997) all new patients had intubation based on these findings, so statistical significance was not achieved in this comparison between the groups.…”

Modified laser DCR for paediatric nasolacrimal duct obstruction

“…8,9 The benefits of endonasal laser DCR are well established in adults with success rates between 63 and 97%. [10][11][12][13][14][15][16] Its role in children is yet to be evaluated and to date there has been only one case-series using the KTP laser with 0% success. 17 We describe our experience with the Holmium : YAG laser using a modified technique in these cases with promising results.…”