Endocanalicular laser dacryocystorhinostomy with mucosal flaps.

PURPOSE: To describe the technique of endocanalicular laser dacryocystorhinostomy with mucosal flap creation and to report the outcomes of this technique.

METHODS

Prospective noncomparative case series of 7 patients with primary acquired nasolacrimal duct obstruction undergoing endocanalicular laser dacryocystorhinostomy with mucosal flap. The mucosal flap was created using an endoscopic endonasal approach. An endocanalicular approach was used to fashion the lacrimal sac opening and the osteotomy of the lacrimal sac fossa.

RESULTS

Nine procedures were performed in 7 female patients. Average patient age was 68±15 years. Intraoperative complications included bleeding during the creation of the mucosal flap in 1 patient. The procedure was associated with no pain to moderate pain in all cases. Anatomical success was achieved in 89% of procedures and symptomatic relief was achieved in 89% of surgeries for an average follow up of 10 ± 5 months. Only 1 patient required an external dacryocystorhinostomy revision because of postoperative restenosis.

CONCLUSIONS

Endocanalicular laser dacryocystorhinostomy provides a minimally invasive approach to epiphora with a good success rate. The addition of a nasal mucosal flap to this technique may aid in proper fistulization and should be studied in larger prospective trials.