How will you perform Laser assisted endoscope DCR? What is the role of Laser in DCR?

• Carefully preoperative assessment done
• Syringing and probing done
• ↓ LA patient is put in supine position and asked to breath from mouth
• Antiseptic dressing and draping done.

The canaliculus is dilated to allow the passage of vitreoretinal light probe . This light probe is passed through the superior canalicular and angled inferiorly to avoid trauma to the inferior canaliculus.

The light probe is then advanced into the lacrimal sac and the point of light can be seen endoscopically (8% cases). the light may be diffused by agger nasi cell of which need to be open prior to enter the lacrimal fossa.)

Using the optimal power the laser ablates the tissue of lacrimal sac.

Once the sac is exposed to light probe is withdrawn to avoid damage to common canaliculus. It is replaced c lacrimal probe to tent the sac medially and further widening of the ostium becomes easier. (Rhinostomy is enlarged to 5-8 mm diameter)

Loop of silicone tent can be done but should not be too tight to cause granulation and “cheese wire”through the canal cut.

Role of Laser in Laser assisted endoscopic DCR

Ideal Laser should have:

1. An ability to ablate soft tissue
2. An ability to ablate bone
3. Good haemostatic properties
4. Deliverable through a flexible laser fiber and
5. Inexpensive

CO2 Laser	Argon Laser	ND:YAG Laser	HO:Yag	Diode Laser	KTP-532 Star pluse Laser	Erbium: YAG
Poor haemostatic	Good soft tissue ablation	Good soft tissue and bone ablation	Good tissue ablation	Good tissue ablation	Good tissue ablation	suitable but no delivery system.
Poor bone ablation	Poor bone ablation	Poor haemostasis	Good haemostatic properties	Good haemostatic	Good haemostana
cannot be delivered through optical fibres.			Spatter and requires repeated cleansing of the endoscopy lens.	Single use fibres so up expenses.	No spattering

Advantages of Endoscopic LASER DCR:

1. No external scars
2. Very less operative time
3. ↓LA (suitable for those unfit for GA)
4. Suitable for patient c bleeding disorder due to minimal bleaching
5. No disruptive medial canthal anatomy and lacrimal pump funtion

Disadvantages of Endoscopic LASER DCR:

1. Laser precaution required
2. Expensive
3. High failure rate due to stenosis and scarring the rhinostomy site.

Advantage of external DCR

1. High success rate.
2. Excellent view of the lacrimal sac
3. Allows biopsy of Lacrimal sac.

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