HOLMIUM LASER CANALICULOPLASTY

Thirty canaliculi of 18 patients with complete or nearly complete cana licular obstruction were subjected to laser canaliculoplasty as a subs titute for the standard Jones-type bypass conduit. Etiologies for the obstruction included congenital lacrimal system atresia, eyelid trauma , scarring following previous lacrimal surgery, and chronic inflammato ry fibrosis. The procedure utilized a holmium laser delivered via a 1, 000 mu optical fiber to cut a 1-mm channel from the punctum into the l acrimal sac. In nine eyes, this procedure was combined with a surgical dacryocystorhinostomy (DCR) for concurrent lower nasolacrimal duct ob struction. Silicone stents were left in place for 6 months postoperati vely. Follow-up data were available for 28 canaliculi of 17 patients. Moderate or better improvement in symptomatic epiphora and evidence of canalicular patency to drainage was seen in 16 of 28 (57%) treated ca naliculi, and significant improvement was recorded in 12 of 28 (43%). Although these figures are lower than those obtainable after repair of small areas of focal canalicular stenosis or obstruction, the procedu re is superior to any previous attempts at reconstruction of extensive obstructions, short of placement of a Jones tube. When successful, th is procedure offers re-establishment of a near normal physiologic syst em, and avoids the complications of and patient dissatisfaction associ ated with a Jones tube.