[Transcanalicular endodacryocystorhinostomy using Neodymium:YAG laser]. / Endodacryocystorhinostomie transcanaliculaire au laser Neodymium: YAG.

UNLABELLED: We describe a new technique of dacryocystorhinostomy (DCR) and we present our first clinical cases. The principle of this technique is to create a fistula between the lacrimal sac and the nose with a quartz fibre advanced through a canaliculus and connected to a Neodymium:YAG. TECHNIQUE: An 800 microns outer diameter metallic pipe was inserted through a lacrimal canaliculus up to bone contact. An optical fibre light probe was inserted through the pipe in order to locate the lacrimal sac in the nasal fossa by translumination using a nasal video-endoscope. The optical fibre light probe was then replaced with a laser fibre and a lacrimo-nasal fistula (approximately 5 mm diameter) was created in a few minutes by juxtaposition of twenty or more 10 watt energy pulses. Finally, a silicone stent was positioned for 6 months. MATERIAL AND METHOD: We have operated 41 DCR using this transcanalicular method with the Nd:YAG laser. Our mean follow-up was 6 months (max 16 months). Indications were stenosis of the naso-lacrimal duct, failed classical DCR, abscesses of the lacrimal sac uncurable by antibiotherapy and canaliculary stenosis. RESULTS: Success rate was 75%, both for primary procedures and for operations after failed classical DCR. CONCLUSION: The advantages of this method are its simplicity, its atraumatic feature, minimal bleeding, the absence of scar and its ability to treat obstructions located at all levels of the excretory lacrimal system. Minimal operating traumatism makes it a very convenient method for out patient clinic.

[Retinal detachment following posterior capsulotomy using a YAG laser]. / Décollement de la rétine après capsulotomie postérieure au laser Yag.

This work analyzes 9 cases of retinal detachment occurred after posterior capsulotomy with Yag laser. No relationship has been found between the timing of the Yag capsulotomy after cataract extraction, and seriousness or precocity of the retinal detachment. The size of the capsulotomy does not seem to play a main part either. The study shows the part of the posterior capsule and the importance of associated risks (myopia, peripheral degenerative lesions, previous retinal detachment in the fellow eye). The role of the Yag laser treatment seems doubtful.

[Indications for vitrectomy in the extraction of intraocular foreign bodies]. / Indications de la vitrectomie pour l'extraction des corps étrangers intra-oculaires.

Vitrectomy represents an important advance for the extraction of intra-ocular foreign bodies, a study of 20 cases emphasizing the advantages of the method. Pars plana vitrectomy was performed using Klöti's vitreous stripper; intra-ocular foreign bodies were extracted through the pars plana incision by a magnet or with forceps. The main indications of the technique are: posterior pole foreign bodies; old embedded metallic foreign bodies; foreign bodies with complications (traumatic cataract, vitreous hemorrhage, retinal detachment); non-magnetic oxidizable foreign bodies: these must be extracted under visual control with vitrectomy techniques, but complications and failure remain common. This technique also has its limits: extraction of non-oxidizable non-magnetic foreign bodies; foreign bodies attached to the ocular globe wall. These are preferably left in place. Vitreoretinal complications were the main reasons for failure in this study. Nevertheless, vitrectomy allows clearing of cloudy media, visualization, localization and extraction of foreign bodies under visual control through the pars plana, and reduction of complications.