TRANSCANALICULAR LASER
DACRYOCYSTORHINOSTOMY.
NEED FOR TECHNICAL STANDARDS
TO COMPARE RESULTS
Dr. José Maeso (1,3) – ENTProf. Dra. Mª Teresa Sellarès (2,3) - Ophtalmology(1) Centre Mèdic Delfos. Centro Internacional de Medicina Avanzada.
(2) Fundació Parc Taulí.Instituto Universitario UAB
(3) Centre Oftalmològic ORL d’Egara.
Mailing adressess:
- Prof. Dra. Mª Teresa Sellarès Fabrés. e-mail: [email protected]
- Dr. José Maeso Riera. e-mail: [email protected]
INTRODUCTION
- Usual practice of TC-DCR with silica-fluopolimer-tefzel guides
- New guides of silica-silica-poliamide (therical better behaviour):
- Narrower exit angle, better laser concentration, less periferal
tissue lesion.
- Bear higher temperatures , less ignition risk, can be sterilized
- Practical use:
- Loss of laser guide
light.
- ‘Phantom’ images
- Very poor increase of
guide light while
shooting
- More energy needed;
more impacts; more
time
MATERIAL and METHODS
Laser INTERmedic® Multidiode S15 OFT 980nm
Si-fluopolimer-tefzel 600µ
Si-Si-poliamide 600µ
- Experimental study to compare both
guides
- Observational surgical behaviour
MATERIAL and METHODS
- CORTICAL THICK BONE:
* thermical behaviour (Cámara termográfica FLYR Infracam®)
* penetration (AMI Micrometer®; 0.01mm resolution)
- 4mm SPONGY BONE: behaviour during osteotomies
500msec/500msec, 10 W; 10 osteotomies
* Total energy needed to achieve osteotomies
- SHEEP HEADS: TC – DCRs
500msec/500msec, 10 W; DCRs
* Total energy needed; Time; Ostium
- SURGERY with Si-Si-poliamide guides (10 eyes)
RESULTS
- CORTICAL THICK BONE
Pulse/Pause
Serie 1 10 sec/3 sec
Power Total Energy
10 W
Serie 2 600msec/600msec 15 W
1000 J
Serie 3 500msec/500msec 15 W
1000 J
Serie 1: temp. > 300º; Si-fluopolimer guide burnt
after 27sec shot
Series 2 – 3: temp. 80º; normal behaviour
No significant differences between guides in penetration
- 4mm SPONGY BONE: 500mseg/500mseg, 10 W; 10 osteotomies
Total Energy Shots
Total laser time
Silica-Fluo
200 J
35
19 sec
Silica-Sílica
252J
42
25 sec
RESULTS
- SHEEP HEADS: TC – DCRs; 500msec/500msec, 10 W.
Total Energy
Silica-Fluo
500 J
Silica-Sílica
648 J
Silica-fluopolimer guide:
- no carbonizing crusts in front of the progression of the fibre; guiding light could be controlled during all the
procedure.
- tunnel that allowed free manoeuvres, with a diameter wider than that of the fibre; easy widening of the osteotomy
by confluence of the different trajects.
Silica-silica guide:
- burning scar masking the guiding spot, producing reflected lights out of the treatment direction.
- narrow diameter of the working tunnel, traping the guide.
- to achieve a proper osteotomy we were forced to practice different perforations, that kept parallel (with a
‘watering can’ image), being more complex to make them converge in one of enough size.
RESULTS
- SURGERY with Si-Si-poliamide guides (10 eyes)
Total Energy (J)
Impact Num
Total láser time
(sec)
373
723
528
623
714
667
640
389
475
596
80
156
107
142
155
148
147
82
95
134
37
73
61
59
71
66
64
42
50
59
558,97
120,90
56,99
Case
1
2
3
4
5
6
7
8
9
10
Mean
- SURGERY with Si-Fluopolimer-tefzel (358 eyes)
Total energy
Mean
378.65 J
Impact Num.
29,07
Total laser time (sec)
27,04
CONCLUSIONS
- Better effectiveness of the silica-fluopolimer- tefzel
guides
- Better surgical behaviour
- Minimum risks
- Inconvenience: it can not be re-sterilized
- Relevant to consider these differences when comparing
studies published evaluating results with the use of laser