TRANSCANALICULAR NEODYMIUM-YAG LASER FOR REVISION OF DACRYOCYSTORHINOSTOMY

Background: Laser-assisted dacryocystorhinostomy (DCR) has failed to m atch the success rates of external DCR. It has been suggested that thi s technology may be best suited for revision of failed DCR cases. The authors prospectively evaluated the efficacy of transcanalicular laser -assisted revision DCR (TCLARDCR). Methods: A neodymium:YAG (Nd:YAG) l aser was used for transcanalicular revision of 24 failed DCRs. Failure had followed one (n = 15), two (n = 7), or three (n = 2) previous ext ernal DCRs. Results: Mean duration of the surgery was 78.2 minutes. Su ccess was achieved in 11 cases (46%; mean follow-up, 20 months). There was no correlation between early loss of stents and failure. Three ca ses had partial relief of symptoms. Three of the failures unsuccessful ly underwent further TCLARDCR. Conclusions: The authors' success rate of 46% with TCLARDCR compares poorly with the 85% success for external revision DCR. With TCLARDCR, specific anomalies like the sump syndrom e cannot be addressed adequately. There is a theoretical risk of canal icular injury. Laser lacrimal surgery also is equipment dependent and more costly than external DCR. The TCLARDCR cannot be recommended for revision DCR using the Nd:YAG laser (Lasersonics, Milpitas, CA).