[Holmium: YAG and neodymium: YAG laser assisted trans-canalicular dacryocystorhinostomy. Results of 317 first procedures].
OBJECTIVE
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 of two anti-metabolite drugs: mitomycin-C (MMC) and 5 fluoro-uracile (5 FU). To analyse the rate of efficiency of the Ho: YAG laser in the canalicular obstructions.


METHODS
Three hundred and seventeen patients were operated: 226 with the Nd: YAG laser, 77 with the Ho: YAG laser and 14 with both lasers; 68 were treated with an application of MMC and 40 patients with an application of 5-FU. Sixty-three patients suffered from a canalicular obstruction.


RESULTS
The results are based on 289 procedures 6 months after the operation. The global rate of success was 63.32% after one intervention and 70.24% after one or two revisions. There is no statistically significant difference between Nd: YAG or Ho: YAG lasers. The use of antimetabolites did not improve the success rate. In 65% of the cases the canalicular patency is reached.


CONCLUSIONS
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 traumatism. 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 dacryocystorhinostomy is impossible. This procedure is less successful than external or endonasal dacryocystorhinostomy. The success rate is not modified by the use of antimetabolites or by the type of laser.
Piaton
J M
JM
Centre National d'Ophtalmologie des Quinze-Vingts, Service du professeur S. Limon, 28, Rue de Charenton, 75012 Paris, France.
Keller
P
P
Limon
S
S
Quenot
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000627:therapeutic use; D000963:Antimetabolites / Q000627:therapeutic use; D002648:Child; D003608:Dacryocystorhinostomy / Q000379:methods*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D005500:Follow-Up Studies; D006695:Holmium; D006801:Humans; D007431:Intraoperative Complications; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D009354:Neodymium; D011182:Postoperative Care; D011183:Postoperative Complications; D013997:Time Factors
D000477:Alkylating Agents; D000963:Antimetabolites; D009354:Neodymium; D016685:Mitomycin; D005472:Fluorouracil; D006695:Holmium