[Transcanalicular endodacryocystorhinostomy using Neodymium:YAG laser]

We describe a new technique of dacryocystorhinostomy (DCR) and we present our first clinical cases. The principle of this technique is to create a fistula between the lacrimal sac and the nose with a quartz fibre advanced through a canaliculus and connected to a Neodymium:YAG.

An 800 microns outer diameter metallic pipe was inserted through a lacrimal canaliculus up to bone contact. An optical fibre light probe was inserted through the pipe in order to locate the lacrimal sac in the nasal fossa by translumination using a nasal video-endoscope. The optical fibre light probe was then replaced with a laser fibre and a lacrimo-nasal fistula (approximately 5 mm diameter) was created in a few minutes by juxtaposition of twenty or more 10 watt energy pulses. Finally, a silicone stent was positioned for 6 months.

We have operated 41 DCR using this transcanalicular method with the Nd:YAG laser. Our mean follow-up was 6 months (max 16 months). Indications were stenosis of the naso-lacrimal duct, failed classical DCR, abscesses of the lacrimal sac uncurable by antibiotherapy and canaliculary stenosis.

Success rate was 75%, both for primary procedures and for operations after failed classical DCR.

The advantages of this method are its simplicity, its atraumatic feature, minimal bleeding, the absence of scar and its ability to treat obstructions located at all levels of the excretory lacrimal system. Minimal operating traumatism makes it a very convenient method for out patient clinic.