Transcanalicular Endoscopic Laser-assisted Dacryocystorhinostomy (TELA-DCR)
Abstract:Objective:To assess the results in combined dacryoendoscopy followed by lacrimal drainage surgery with a transcanalicular laser-assisted approach combined with microsurgical endonasal DCR (TELA-DCR).
Methods:Retrospective follow-up of a case series between 1998 and 2003. 82 patients were included in the study (43 females/39 males, age 47.8 years). All patients underwent a combined examination by an ophthalmologist (GVA) and an otorhinolaryngologist (AS/KL) consisting of a routine clinical examination of the eyes, the lacrimal system and the nasal cavity as well as the paranasal sinuses with probing and syringing of the lacrimal drainage system, a radiological examination with digital subtraction dacryocystography (dsDCG) and computerized tomography (CT) of the bony structures. Of 122 lacrimal systems with dacryoendoscopy (Schwind Vitroptic®, Germany), 68 had a bicanalicular silicone intubation without surgery, 12 had a transcanalicular laserdacryoplasty (Erb:YAG-Laser; Schwind-Sclerostome®, Germany) with bicanalicular silicone intubation (Ritleng; FCI Ophthalmics, France) and 42 had TELA-DCR with a silastic-sheet inlay in the bony window for two to three days. 7 of these 42 have already had lacrimal surgery elsewhere. 2 had external lacrimal surgery (Toti procedure) and 5 had endonasal surgery (West procedure). Dacryoendoscopy was used to review the diagnosis of digital subtraction dacryocystography (dsDCG) and for surgical intervention in the same session. Surgery was done in general anesthesia. All patients were admitted to the inpatient department for 24 hours and were discharged the day after surgery. Follow-up (4–65 months) was done by the surgeons only. The silicone tubes were left for three to six months and removed endonasally by the same surgeons again.
Results:Of 122 interventions with dacryoendoscopy 68 needed a bicanalicular stenting with a silicone tube for relative stenosis only. 12 of these needed further intervention by DCR (17.6%) due to restenosis. 12 out of 122 had primary laserdacryoplasty and 2 (16.6%) of these needed DCR later. 42 of 122 had primary TELA-DCR. 5 out of these 42 primary TELA-DCR were revision-DCR after external or endonasal DCR elswhere and 2 of these needed a 2nd TELA-DCR for restenosis (4.8%). Anatomically all lacrimal systems are still patent ever since. 76 patients (92.7%) are free of symptoms. Overall anatomic patency rate was 82.4% in tubing as single intervention, 83.4% in laser-dacryoplasty and 95.2% in TELA-DCR.
Conclusions:Combined dacryoendoscopy and TELA-DCR is an efficient, safe and successful method in the managment of lacrimal obstructive disease. Our experience suggests that TELA-DCR may be considered as a treatment option in selected patients with lacrimal obstructive disease.
Document Type: Research Article
Affiliations: Hirslanden Klinik Aarau, Schänisweg, Aarau, Switzerland
Publication date: December 1, 2003