NEODYMIUM-YAG LASER-ASSISTED TRANSCANALIC ULAR ENDODACRYOCYSTORHINOSTOMY

We describe a new technique of dacryocystorhinostomy (DCR) and we pres ent our first clinical cases. The principle of this technique is to cr eate a fistula between the lacrimal sac and the nose with a quartz fib re advanced through a canaliculus and connected to a Neodymium:YAG. Te chnique An 800 mu m outer diameter metallic pipe was inserted through a lacrimal canaliculus up to bone contact. An optical fibre light prob e was inserted through the pipe in order to locate the lacrimal sac in the nasal fossa by translumination using a nasal video-endoscope. The optical fibre probe was then replaced with a laser fibre and a lacrim o-nasal fistula (approximately 5 mm meter) was created in a few minute s by juxtaposition of twenty or more 10 watt energy pulses. Finally, a silicone stent was positioned for 6 months. Material and method We ha ve operated 41 DCR using this transcanalicular method with the Nd:YAG laser. Our mean follow-up was 6 months (max 16 months). Indications we re stenosis of the naso-lacrimal duct, failed classical DCR, abscesses of the lacrimal sac uncurable by antibiotherapy and canaliculary sten osis. Results Success rate was 75 %, both for primary procedures and f or operations after failed classical DCR. Conclusion The advantages of this method are its simplicity, its atraumatic feature, minimal bleed ing, the absence of scar and ifs ability to treat obstructions located at all levels of the excretory lacrimal system. Minimal operating tra umatism makes it a very convenient method for out patient clinic.