title: Transcanalicular neodymium: YAG laser for revision of dacryocystorhinostomy.
abstract: BACKGROUND
  Laser-assisted dacryocystorhinostomy (DCR) has failed to match the success rates of external DCR. It has been suggested that this 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) laser was used for transcanalicular revision of 24 failed DCRs. Failure had followed one (n = 15), two (n = 7), or three (n = 2) previous external DCRs.
  
  
  RESULTS
  Mean duration of the surgery was 78.2 minutes. Success was achieved in 11 cases (46%; mean follow-up, 20 months). There was no correlation between early loss of stents and failure. Three cases had partial relief of symptoms. Three of the failures unsuccessfully 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 syndrome cannot be addressed adequately. There is a theoretical risk of canalicular 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).
authors.affiliation: John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City 84132, USA.
authors.forename: B C
authors.initials: BC
authors.lastname: Patel
authors.forename: B
authors.initials: B
authors.lastname: Phillips
authors.forename: W M
authors.initials: WM
authors.lastname: McLeish
authors.forename: P
authors.initials: P
authors.lastname: Flaharty
authors.forename: R L
authors.initials: RL
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000535:Aluminum; D002648:Child; D003608:Dacryocystorhinostomy; D005260:Female; D006801:Humans; D053685:Laser Therapy; D007834:Lasers; D008297:Male; D008875:Middle Aged; D009354:Neodymium; D011446:Prospective Studies; D012086:Reoperation; D017211:Treatment Failure; D016896:Treatment Outcome; D015019:Yttrium
chemical_list: D009354:Neodymium; D015019:Yttrium; D000535:Aluminum