Page 18 - Revista SPORL - Vol 58. Nº1

years. A P value of 0.05 or less were considered statistically FIGURA 1
significant. Transcanalicular Diode Laser-Assisted Dacryocystorhinostomy
Results: Of the 258 patients included in the study, External-DCR technique: (1) Probing lacrimal pathway; (2) Diode laser
were performed on 122 eyes, with surgical success reported in introduction; (3) Ablation/vaporization of the lacrimal sac/
90.9% of cases; 179 eyes performed transcanalicular-DCR, with bone with diode laser with lacrimal sac exposure; and (4)
a success rate of 92.2%; no significant difference was observed Bicanicular probe placement.
between the two techniques (p=0.712). In group aged ≥65
years, the success rate varied between 87.7%-89.6%, with a
statistically significant difference, (p=0.021) compared to the
higher success rates observed in the younger group (between
93.3%-97.5%).
Conclusions: Both techniques, External-DCR and
Transcanalicular-DCR, have high and comparable success rates.
Although the success rate in the population over 65 is statistically
lower than that seen in the younger population, surgical success
rates remain high and without further complications.
Keywords: Dacryocystitis; Epyphora; Dacryocystorhinostomy

INTRODUCTION
Acquired nasolacrimal duct obstruction (NLDO) is a fairly
common disorder that occurs more frequently in females than
in males1. The most common clinical manifestations of acquired
NLDO are epiphora and acute or chronic dacryocystitis.
Dacryocystorhinostomy (DCR) has been established as the
prevailing procedure for acquired NLDO2. External (EX-),
Endoscopic (EN-), and Transcanalicular (TC-) DCR approaches
based on the formation of a fistula between the nasal cavity
and the lacrimal sac to ensure the continuity of the lacrimal
drainage system can be used. Toti3 first defined EX-DCR in 1904,
and Dupuy-Dutemps and Bourguet4 modified this procedure
that has become the traditional and gold standard treatment of
acquired nasolacrimal duct obstruction.Caldwell first described
EN-DCR in 1893 and West and Halle later modified it5. These
techniques were limited in use due mainly to the difficulty in
visualizing the endonasal anatomy during the operation. The
development of the operating microscope and rigid endonasal
endoscope, made this technique popular again.
Improvements in lasers and laser devices allow
surgeons to use minimally invasive techniques, including
transcanalicular approaches6. The first transcanalicular laser
dacryocystorhinostomy was performed with an argon laser7.
Diode laser, holmium: yttrium-aluminum-garnet, potassium-
titanyl-phosphate, CO2 and neodymium: yttrium-aluminum-
garnet laser were other types of laser used for TC-DCR8. Today,
TC-DCR with a diode laser has been frequently utilized to
treat primary NLDO9,10. In this procedure, a probe is inserted
through the punctum via the canaliculus into the lacrimal sac
following the anatomical pathway of tear outflow. Osteotomy
is performed by laser energy through an optic fibre which is
inserted within the probe. It has to be ensured that the aiming
beam is at the brightest and is not scattered. Laser is fired only
after confirmation in short pulses with equal gap intervals11 -
Figure 1.
In the literature, successful results have been reported using
TC-DCR method12. Although the short-term results of TC-DCR
have been reported in previous studies, the long-term results
are still unclear. Moreover, although dacryocystorhinostomy is
the definitive treatment for NLDO and has a high success rate
reported in the literature (80% e100%) with a low complication
rate (1%-6%), very few studies evaluate the specific outcomes
for an elderly population13. Multiple factors confer an increased
surgical risk on elderly patients, including functional decline,

16 REVISTA PORTUGUESA DE OTORRINOLARINGOLOGIA E CIRURGIA DE CABEÇA E PESCOÇO