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Joshi, Rajesh S

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Indian Journal of Ophthalmology: January 2013 - Volume 61 - Issue 1 - p 45
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I thank Yıldırım et al. for their interest in my article.[1] I do agree that the success rate of transcanalicular laser-assisted dacryocystorhinostomy (TCLADCR) in our study was low. Reasons for the failure of the TCLADCR have already mentioned in our study. The authors have quoted studies from the literature with success rate of TCLADCR to the tune of 80-88%.[23] The high success rate in these studies could be due to the different selection criteria, variation in the anatomy of the nasolacrimal system, wound healing, tissue response to the laser, stenting of the lacrimal system, use of mitomycin to prevent proliferation of the fibrous tissue, and the procedure being done with a different aim. Narioka and Ohashi performed TCLADCR in the failed cases of conventional dacryocystorhinostomy (DCR).[2] Therefore, it is impossible to compare the failure rate of TCLADCR in our study with the studies quoted by the authors. Nevertheless, our study was about conventional DCR and not about TCLADCR. For the same reason detailed data about TCLADCR was not mentioned.

All the patients were thoroughly examined for nasal pathology by an Ear, Nose, and Throat (ENT) surgeon. Only patients having nasolacrimal duct obstruction were selected for the procedure (initial treatment by TCLADCR as well as conventional DCR, in failed cases of TCLADCR). For this reason, improper case selection has nothing to do with the failure of the TCLADCR.

The authors have mentioned lacrimal fistula and performing TCLADCR. We had clearly mentioned in the discussion that fistula was formed after an attack of acute dacryocystitis in failed cases of TCLADCR. Presence of lacrimal fistula was an exclusion criterion for TCLADCR.

Performing repeat TCLADCR in failed cases would have increased the success rate in our case series. However, we preferred to use conventional DCR, in the interest of the patient, to ensure a successful outcome of the disease. I do agree about the use of a flexible microendoscope to understand the pathological changes in the lachrymal system and treat them, but this facility was not available at our center.

1. Joshi RS. Conventional dacryocystorhinostomy in a failed Trans-canalicular laser-assisted dacryocystorhinostomy Indian J Ophthalmol. 2011;59:383–5
2. Narioka J, Ohashi Y. Transcanalicular-endonasal semiconductordiode laser assisted revision surgery for failed externaldacryocystorhinostomy Am J Ophthalmol. 2008;146:60–8
3. Plaza G, Beteré F, Nogueira A. Transcanalicular dacryocystorhinostomy with diode laser: Long-term results Ophthal Plast Reconstr Surg. 2007;23:179–82
© 2013 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow