Results of endoscopic KTP laser-assisted dacryocystorhinostomy

Nineteen consecutive cases of primary endoscopic potassium titanyl phosphate (KTP) laser-assisted dacryocystorhinostomy (DCR) were retrospectively studied. Follow-up ranged from 10 to 16 months. Patients ranged in age from 18 to 93 years (average 65.6 years). Preoperative epiphora was present in all patients, and associated with mucopyocele in nine patients. Bicanalicular-nasal silicone tubes were placed during surgery in all cases. Timing of tube removal in the office ranged from 5 to 15 weeks (average 8.9 weeks). Prolonged patency through the follow-up period was achieved in 13 of 19 cases (68.4%). The six cases (31.6%) of postoperative failure included three cases with preoperative mucopyocele and three cases without. Failures manifested with recurrent epiphora (three cases) or recurrent dacryocystitis (three cases); the onset of symptom recurrence varied from 7 to 27 weeks postoperatively (average 18.3 weeks). Although success rates will vary between surgeons and study populations, patients should be advised that the success rate of KTP laser-assisted DCR may be lower than that of standard DCR. Generally, indications for choosing laser-assisted DCR include the avoidance of a cutaneous incision and reduced potential for mucosal bleeding. The technique may be considered for use in selected cases of nasolacrimal obstruction. The importance of technical variations remains to be elucidated including rhinostomy size and timing of silicone tube removal. Further studies are needed to help define the role of endoscopy techniques and lasers in DCR surgery.