EFFICACY OF DIODE LASER TRANSCANALICULAR DACRYOCYSTORHINOSTOMY FOR THE TREATMENT OF ACQUIRED NASOLACRIMAL DUCT OBSTRUCTION

This study designed to determine the surgical outcome of transcanalicular dacryocystorhinostomy for the treatment of blocked lacrimal pathway. This is a prospective study of 36 patients admitted in Basrah General Hospital from March 2008 to May 2010. The age of the patients was in range from 6 to 60yrs. Forty five (31.25%) were males and 99(68.75%) were females. All of these cases were unilateral. Thirty three (93.05%) of the total patients were operated general local anesthesia and the rest 3 (6.94%) were under local anesthesia. The overall success rate was 62.5% in non-intubated patients and 93.75% with intubation. It is concluded that Diode Laser Transcanalicular dacryocystorhinostomy is still a new surgical procedure for the treatment of nasolacrimal duct obstruction and need further refinement of the surgical procedure and studies for evaluation of effectiveness and success. Introduction atering eye (epiphora) and pus discharge are the usual presenting symptoms of a patient who is suffering from a nasolacrimal duct obstruction. The condition is characterized by positive regurgitation test, matting of the eye lashes and recurrent conjunctivitis. Sometimes the condition complicates and results in pain, swelling and even pus formation. In children the disease occurs because of the delayed canalization of the lacrimal pathway. The procedure of choice in most of these conditions is dacryocystorhinostomy (DCR). The classical operation was first introduced by Toti1 in 1942 and modified by Bourguet 1,2 . It involves external incision over the lacrimal sac and creation of a fistula through the nasal bone directly into the nasal cavity. Transcanalicular DCR is a new procedure involves Transcanalicular opening in the lacrimal sac and the nasal bone passing the nasal mucosa into the nasal cavity using diode laser probe and then insertion of a tube which remain in situ for 3 months. Material and methods This is a prospective study of 36 patients admitted in Basrah General Hospital from March 2008 to May 2010. All these patients had a clinical diagnosis of a nasolacrimal duct obstruction. All these patients were hospitalized and detailed ophthalmic and nasal examinations were carried out. The site of obstruction was evaluated with regurgitation and lacrimal sac irrigation test. Other diagnostic procedure like dacryocystography and Jones test were not performed. Most of the operations were carried out under general anesthesia and in unfit patients local anesthesia with using Xylocaine 2% was used with Adrenaline 1:10000 to decrease potential intra and postoperative bleeding. A nasal packed soaked with 2% W Efficacy of diode laser DCR in acquired nasolacrimal duct obstruction Salah Al-Asadi, & Ahmed Al-Abbasy Bas J Surg, September, 17, 2011 65 Xylocaine and two vials of injection adrenaline was applied in ipsilateral nasal cavity in almost all cases. The puncti dilated with Nettleship dilater and using Bowman probes the canaliculi were dilated up to the medial wall of the lacrimal sac (hard stop). The fibroptic probe of a Diode 812 nm Laser in repeated pulse mode about 8 mW, 0.2 second repetition time, 0.2 pulse duration. With nasoscopic aid the nasal cavity is visualized directly or through a screen monitor. Laser is used to open the medial wall of the nasal cavity and the underlying bony structures passing through the nasal mucosa to the nasal cavity. The same procedure done with the upper canaliculus. Using the usual lacrimal intubation tube, the metallic probe is passed to the nasal cavity where the rhinologist pass it out of the nose, the other tube is also passed out of the nose where both are tied together. Waxed nasal packing applied to both nostrils. Post operative medications included systemic antibiotics, analgesic and tranxaminic acid. Each patient discharged from the hospital after 24 hours postoperatively and was reviewed two days postoperatively for removal of the nasal packing. The lacrimal tube was removed after 3-6 months of surgery. The success criteria were absence of watering and regurgitation on pressure and patency of lacrimal pathway on syringing. Results This study included 36 patients in which 11 (31.25%) were males and 25(68.75%) were females (Table I). Table I: Ditribtion of patients according to sex. Gender No. of patients n (%)