Transcanalicular THC:YAG dacryocystorhinostomy.

Chromium-sensitized and thulium- and holmium-doped YAG lasers (THC:YAG laser) were used to create a nasal bony ostium in the area of the lacrimal sac fossa in four fresh frozen bisected human cadaver heads. The lasers-long pulsed (300 milliseconds), compact, self-contained, and solid state--operate in the near infrared (2.1 microns). The opening was created by passing the 320-micrometer laser fiber across the canalicular system. Pulse energies of 250 to 900 mJ were used with a repetition rate of 5 to 15 pulses per second. Energy levels ranging from 1.25 to 9 W produced a full-thickness bony ostium approximately 3 to 4 mm in diameter. Silicone tubing was then threaded through the superior and inferior canaliculus system in the standard fashion. This technique may simplify conventional dacryocystorhinostomy as well as endonasal laser dacryocystorhinostomy procedures.

Generalized fibrosis of the extraocular muscles.

We studied four patients with the general fibrosis syndrome. One patient had bilateral inguinal hernias and unilateral cryptorchism; the other patients had no other congenital abnormalities. The patients developed normally both neurologically and metally. We successfully treated amblyopia and achieved good functional and cosmetic results with strabismus and blepharoptosis surgery. Histopathologic study revealed fibrous infiltration of extrinsic eye muscle and Tenon's capsule without inflammatory changes.