ĐÁNH GIÁ KẾT QUẢ BAN ĐẦU PHẪU THUẬT NỐI THÔNG TÚI LỆ MŨI NỘI SOI CẢI TIẾN DƯỚI SỰ HỖ TRỢ CỦA LASER

Abstract

Objective: To analyze the efficacy and safety of a modified endoscopic laser-assisted dacryocystorhinostomy (DCR). Study Design: A prospective interventional case series. Methods: Twenty-nine eyes from 29 patients aged over 18 years (ranging from 42 to 90 years, with a mean age of 61.2 ± 11.1 years) underwent modified endoscopic multidiode laser-assisted DCR. The technique involved creating a bony ostium from inside the nasal cavity to treat primary acquired nasolacrimal duct obstruction (PANDO). The mean follow-up duration was 6 months. Results: Among the patients, 28 (96.6%) were female and 1 (3.4%) was male. Mild nasal septal deviation was observed in 6.9% of cases, and middle turbinate hypertrophy was noted in another 6.9%. Prior to surgery, the majority (86.2%) presented with grade 3 epiphora according to the Sahlin scale. Preoperative diagnoses included chronic dacryocystitis with mucopurulent discharge in 69% of cases and simple nasolacrimal duct obstruction with isolated tearing in 31%. At the 6-month follow-up, the mean size of the osteotomy was 5 ± 3.38 mm. The average tear meniscus height decreased from 0.91 mm preoperatively to 0.28 mm postoperatively. Anatomical and functional success rates were 93.1% and 89.6%, respectively. Two cases (6.9%) developed synechiae between the middle turbinate and the osteotomy site, resulting in recurrent obstruction by the 6-month mark. Conclusion: Modified endoscopic laser-assisted DCR is a highly effective and safe surgical approach for treating PANDO. The technique overcomes the challenges of conventional transcanalicular approaches, minimizes the risk of thermal injury to the nasal turbinates and adjacent tissues, and allows for easier manipulation and creation of a large osteotomy.