Transcanalicular diode laser assisted dacryocystorhinostomy.

AIM OF THE STUDY: To assess the validity of transcanalicular diode laser assisted dacryocystorhinostomy (TLADCR) in the treatment of distal obstruction of the lachrymal pathways. MATERIAL AND METHOD: Between June 1999 and February 2000, 29 TLADCR were performed in the ENT department on 26 patients. Surgical indications included chronic dacryocystitis in 19 cases and dacryostenosis in 10 cases. In all cases but one, the surgery was carried out under a standard general anesthetic. The diode laser was used with a power setting of 10 watts. RESULTS: Seventeen out of 29 TLADCR were regarded as having successful outcomes. 2 out of 29 TLADCR had a little persisting tearing regarded as non debilitating and much less than which was present preoperatively. In 10 out of 29 TLADCR, the procedure was deemed a failure. These failures included 4 out of the 10 primary dacryostenosis and 6 out of the 19 chronic dacryocystitis. Two patients refused further treatment. In the other 8, surgical revision was undertaken via the traditional endonasal approach. In 7 of these cases, the lachrymal system was full of purulent secretions. COMPLICATIONS: Two patients developed a partial stenosis of one canaliculus that was diagnosed during the surgical revision. Another patient had a small fistula between the canalicular system and the skin of the corner of the eye that disappeared after the revision surgery. In one other case, the superior canaliculus was cauterised by the denudated portion of a resculpted laser fibre. Two bicanalicular nasal stent required reinsertion. Three patients developed a granuloma around the stent. Four patients developed an episode of infection whilst the stent was still in situ. CONCLUSION: Transcanalicular diode laser assisted dacryocystorhinostomy (TLADCR) performed with a 600-micron contact fibre is a relatively simple, elegant and effective procedure when used in conjunction with nasal endoscopy, to treat distal obstruction of the lachrymal pathways. But, the cost, the high prevalence of minor complications and the currently higher reported failure rate would favour external or endonasal approaches over this approach.