Holmium: YAG and Neodymium: YAC laser assisted trans-canalicular dacryocystorhinostomy. Results of 317 first procedures

Purpose: To assess the results of the first procedures of trans-canalicular dacryocystorhinostomy according to two different lasers: Neodymium : YAG ( Nd: YAG) laser or Holmium : YAG (Ho:YAG) laser. To study the efficiency oi two anti-metabolite drugs: mitomycin-C (MMC) and 5 fluoro-uracile (5 FU). T o analyse the rate of efficiency of the Ho: YAG laser in the canalicular ob structions. Methods: Three hundred and seventeen patients were operated: 226 with the N d: YAG laser, 77 with the Ho: YAG laser and 14 with both lasers; 68 were tr eated with an application of MMC and 40 patients with an application oi 5-F U. Sixty-three patients suffered from a canalicular obstruction. Results: The results are based on 289 procedures 6 months after the operati on. The global rate of success was 63.32% after one intervention and 70.24% after one or two revisions. There is no statistically significant differen ce between Nd: YAG or Ho: YAG lasers, The use of antimetabolites did not im prove the success rate. In 65 % of the cases the canalicular patency is rea ched. Conclusion: Laser-assisted transcanalicular dacryocystorhinostomy is a very useful method because it does not cause cutaneous scarring and for it has a low rate of morbidity given that it causes very little surgical traumatis m. Consequently, it can be used under topical anaesthesia and for patients at risk or suffering from coagulation problems. It can be undertaken in the cases of extremely narrow nasal fossae when an endonasal dacryocystoihinos tomy is impossible. This procedure is less successful than external or endo nasal dacryocystorhinostomy. The success rate is not modified by the use of antimetabolites or by the type of laser.