Transcanalicular laser dacryocystorhinostomy using low energy 810 nm diode laser

Endocanalicular Laser Dacryocystorhinostomy and its modifications: A systematic review of techniques and success rates

OBJECTIVE

the main objective of this work is to review the articles that refer to transcanalicular diode laser dacryocystorhinostomy (TCL-DCR) in acquired nasolacrimal duct obstruction (NLDO), as well as its modifications.

MATERIAL AND METHODS

A systematic review of publications related to TCL-DCR of the lacrimal duct from 2000 to March 2021 was carried out in the MEDLINE, EMBASE and COCHRANE LIBRARY databases. The search terms in Spanish and English were: «Endocanalicular laser», dacryocystorhinostomy or «primary DCR-L» or «laser» and «tear ducts».

RESULTS

After subjecting the articles to the inclusion and exclusion criteria, we got 49 articles: 21 retrospective and 28 prospective studies. The bibliometric result obtained guaranteed, for this review, a level C recommendation according to the Scottish Intercollegiate Guidelines Network scale.

CONCLUSIONS

Currently, the classic TCL-DCR has lower success rates than its modifications, so we suggest using the latter. We prefer TCL-DCR with IS-MMC or TCDL associated with endoscopy techniques, without being able to opt for any option, since their success rates are very similar. We leave the choice to the discretion of the surgeon, depending on the management skills of endonasal techniques. More studies, with longer follow-up, and better defined criteria are necessary to clarify which is the best TCL-DCR technique.

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

Introduction

Transcanalicular laser DCR (TL-DCR) approaches have been developed for the formation of a fistula between the nasal cavity and the lacrimal sac to ensure the continuity of the lacrimal drainage system over the years. However, the success rate of TL-DCR has varied widely.

Aim

To evaluate and compare the success rates of conventional transcanalicular multidiode laser dacryocystorhinostomy and modified transcanalicular multidiode laser dacryocystorhinostomy.

Material and methods

Ninety-one eyes of 91 adult patients admitted with epiphora and diagnosed with chronic dacryocystitis were included in the study. The participants were divided into two groups. Group 1 consisted of 55 patients who were treated with conventional transcanalicular laser dacryocystorhinostomy. Group 2 consisted of 36 patients to whom the same surgical procedure was applied with the difference of nasal mucosa excision prior to laser osteotomy. The groups' intraoperative surgical ostium size, perioperative and postoperative complications, operative times and success rates were compared.

Results

The mean follow-up periods for each group were 8.88 ±2.99 months and 10.28 ±4.47 months, respectively (p = 0.077). Intraoperative mean surgical ostium sizes were 31.85 ±14.98 mm² and 42.25 ±18.09 mm², respectively (p = 0.004). The mean operation time in group 1 was significantly shorter compared to group 2 (18.55 ±4.05 min and 24.44 ±3.18 min, respectively, p = 0.0001). The overall success rate was 65.45% in group 1 and 75.00% in group 2 (p = 0.335).

Conclusions

Although the surgical ostium area was significantly greater in group 2, there was no significant difference in surgical success and patient satisfaction rates between the two groups.

[Minimally invasive bypass surgery for nasolacrimal duct obstruction : Transcanalicular laser-assisted dacryocystorhinostomy]

BACKGROUND

In recent years, the minimally invasive surgical procedure of transcanalicular laser-assisted dacryocystorhinostomy (TKL-DCR) has gained importance in the treatment of primary acquired nasolacrimal duct obstructions (PANDO).

OBJECTIVES

Surgical indications, functional success rates, potential advantages, and complications of TKL-DCR are presented and compared with the standard procedures external (EXT-DCR) and endonasal DCR (EN-DCR).

METHODS

The study comprises a PubMed literature review and our own clinical results.

RESULTS

Using TKL-DCR either as the primary surgical treatment for PANDO, or as a secondary procedure following failure (reobstruction of the surgical ostium) of previous EXT-DCR resulted in good functional success rates (60-90%). The duration of surgery (10-15 min) and the period of recovery are significantly shorter than in EXT-DCR. Visible cutaneous scars and significant postoperative nose bleeding are not among the complications of TKL-DCR, due to the lack of a skin incision and the coagulative ability of the diode laser. The smaller sized surgical ostium has been considered the main disadvantage of TKL-DCR, since it might be prone to earlier reobstruction. On the other hand, TKL-DCR spares the anatomical structures that form the physiological tear pump, which should favor tear drainage. In very few cases, thermal damage to the canaliculus has been observed as a complication.

CONCLUSIONS

Given the satisfying functional results, TKL-DCR is a valid alternative to the "gold standard" procedure EXT-DCR, especially in patients who particularly request speedy recovery and who do not want to take the risk of visible skin scaring. Future studies will have to investigate whether the smaller surgical ostia of TKL-DCR remain patent and whether functional success rates decrease during a longer follow-up period of >2 years.

Postoperative changes in olfactory function after transcanalicular diode laser dacryocystorhinostomy

PURPOSE

Transcanalicular diode laser dacryocystorhinostomy (TCL-DCR) is used much in recent years for the surgery of nasolacrimal duct obstruction (NLDO). Although TCL-DCR is accepted to be minimally invasive, safe, and effective, there is no report focusing on postoperative changes in olfactory function after this procedure. Hence, the aim of this current study was to investigate the changes in olfactory function after TCL-DCR procedure.

MATERIALS AND METHODS

This study was carried out in 42 volunteers (16 men and 26 women) between the ages of 20 and 81 years. All participants received detailed lateralized olfactory tests preoperatively and at the postoperative first week, first month, third month, and sixth month. After lateralized olfactory tests were performed, the results were grouped according to the side of the nasal passage where the operation was performed for NLDO: the nonoperated side served as the control.

RESULTS

The current investigation produced 2 major findings: (1) olfactory function decreased significantly after TCL-DCR procedure at the operated side of the nose compared with the nonoperated side; (2) olfactory abilities of the patients returned to normal within 3 months.

CONCLUSION

The results of this study showed that transcanalicular diode laser could be used safely in terms of olfactory function for dacryocystorhinostomy. Temporary decrease of olfactory function on the side having TCL-DCR should be taken into account when obtaining informed patient consent.

Analysis of age as a possible prognostic factor for transcanalicular multidiode laser dacryocystorhinostomy

Purpose. To assess the prognostic value of age on the outcome of transcanalicular multidiode laser dacryocystorhinostomy (TCL-DCR) in patients with acquired nasolacrimal duct obstruction (NLDO). Methods. The medical records of TCL-DCR performed between March 2009 and September 2013 were reviewed retrospectively. Inclusion criteria include over 20 years of age, similar mean follow-up period, and similar mean duration of stenting. The main outcome is surgical success. The effect of age on success rate is also evaluated. Results. The anatomical success was 52% in Group 1 (20-30 years), 56% in Group 2 (31-40 years), 64% in Group 3 (41-50 years), 76% in Group 4 (51-60 years), and 88% in Group 5 (over 60 years). The statistical difference among Group 1 and Group 5, in terms of surgical success rate, was found to be significant (P = 0.009). Additionally, the 20-30-year-old patients had a failure rate 6.76 times higher than that of the over-60-year-old patients (P = 0.009; 95% CI, 1.605-28.542). Conclusion. TCL-DCR is a surgical treatment option for NLDO for which a skin incision can be avoided. The success rate of TCL-DCR for younger population is lower when compared with elderly population.

The effectiveness of postoperative early ostium cleaning in transcanalicular diode laser-assisted dacryocystorhinostomy

PURPOSE

To search the effectiveness of postoperative first week ostium cleaning in transcanalicular diode laser-assisted dacryocystorhinostomy (TDL-DCR).

MATERIALS AND METHODS

A total of 123 eyes of 123 patients with acquired dacryostenosis who had surgery were retrospectively evaluated. Diode laser was used in all patients. All patients were operated under local anesthesia by a single surgeon. Intranasal endoscopic cleaning of the ostium by surgical suction under local anesthesia was performed as an extra job in the postoperative first week visit.

RESULTS

Mean age of the patients was 55 (range, 41-78 years) years. Mean follow up was 13.4 months. Successful outcomes were achieved in 117 of 123 (95.1%) patients. Reoperation was performed in 6 patients with restenosis and were free of symptoms in 1-year follow up.

CONCLUSION

Postoperative first week cleaning of the nasal ostium by surgical suction with the aiding of nasal endoscopy is a very effective method increasing the success rate of TDL-DCR.

Comparison of transcanalicular diode laser dacryocystorhinostomy and external dacryocystorhinostomy in patients with primary acquired nasolacrimal duct obstruction

BACKGROUND AND OBJECTIVE

To compare the success, complication, and patient discomfort rates of transcanalicular diode laser dacryocystorhinostomy (TCDL-DCR) and external dacryocystorhinostomy (EX-DCR) surgeries performed in patients with primary acquired nasolacrimal duct obstruction.

MATERIALS AND METHODS

Eighty consecutive patients were included in the study, and groups were assigned according to DCR technique. Thirty-four (42.5%) patients received TCDL-DCR (Group A) and 46 (57.5%) patients (Group B) received EX-DCR with temporary silicone stent intubation. The success of surgery was determined by the relief of epiphora, patient satisfaction, endoscopic evaluation of ostium patency, and lacrimal system syringing. Pearson Chi-Square test, Fisher's Exact test, and Student's t-test were used for statistical analyses.

RESULTS

Group A included 22 females and 12 males with a mean age of 49.1 ± 15.1 years, Group B included 35 females and 11 males with a mean age of 50.8 ± 11.7 years. There was no difference between groups in terms of age and gender (P = 0.905 and P = 0.167, respectively). The duration of the operation was 22.2 ± 4.8 minutes for Group A, while it was 56.3 ± 15.7 minutes for group B (P = 0.0001). In two patients in Group A, injury in the medial turbinate was recorded, and in Group B, 14 patients experienced mild to severe perioperative bleeding. The perioperative complication rate was significantly different between the groups (P = 0.004). Success in relieving symptoms was 79.4% for Group A and 89.1% for Group B. The difference in the success rates was not statistically significant (P = 0.229).

CONCLUSIONS

Although EX-DCR success rate was higher than that achieved with TCDL-DCR, the latter, with its shorter duration of surgery, lower perioperative complication rate, and a similar success rate, may be a good and acceptable surgical alternative in treatment of primary acquired nasolacrimal duct obstruction.