Early results for laser-assisted dacryocystorhinostomy may be disappointing, speaker says

Michael T. Yen

MIAMI — Despite recent U.S. Food and Drug Administration approval, diode laser for dacryocystorhinostomy may not meet expectations, a presentation here suggested.

"When it comes to technology in lacrimal surgery, I think we need to look at the results and not just get caught up in the technology and the marketing," Michael T. Yen, MD, said at the Bascom Palmer Eye Institute 50th Anniversary Scientific Meeting.

Dacryocystorhinostomy (DCR) and conjunctivodacryocystorhinostomy (CDCR) for nasolacrimal duct obstructions were initially performed through external incision, but laser assistance is now entering the treatment paradigm.

Of 26 surgeries performed by Dr. Yen and colleagues between August 2010 and June 2011 with an average follow-up of 151 days, complete resolution of epiphora occurred in approximately 26% of patients, and roughly 64% of patients felt that their epiphora was significantly better but still experienced some tearing. Re-operation rate was approximately 27%.

"I don't think that the laser DCR is really ready for prime time yet. It is a great concept, but the results just really are not there to justify its use," Dr. Yen said.

He believes that the high failure rate may be attributed to excessive postoperative fibrosis or laser scatter.

"I think laser DCR, CDCR shows promise, but success does not approach that of non-laser techniques. Maybe there are things we can do to refine this procedure, like using improved shielding with the probe, using mitomycin C, etc.," Dr. Yen said. "I think laser assistance may be desired in a very select patient group, but at this stage, for most patients, I would not recommend the procedure."

Disclosure: Dr. Yen has no relevant financial disclosures.