Page 19 - Revista SPORL - Vol 58. Nº1

reduced reserve capacity, polypharmacy, and comorbid medical
conditions14,15.
The purpose of this study was to (1) compare the subjective
surgical success rates reported by patients between TC-DCR
(using a diode laser) and EX-DCR and (2) compare the surgical
success between two different age groups: <65 years versus ≥
65 years
MATERIAL AND METHODS
We performed a retrospective study that included patients
who underwent dacryocystorhinostomy (EX-DCR or TC-DCR) at
the Centro Hospitalar Universitário do Porto, between January
2014 and December 2018. All patients aged ≥ 18 years; with
unilateral or bilateral idiopathic lacrimal pathway obstruction at for the patient. In all of these cases, confirmation was made by
the level of the lacrimal sac or nasolacrimal duct, were included
in the study. The evaluation was performed 6 to 8 months
after surgery. Patients were excluded if they previously had
undergone any surgery for tearing; were younger than 18 years
at the time of surgery; if lack of complete clinical information
in the process or loss of follow-up; if non-idiopathic NLDO,
that is, cases where we identify a specific cause like exposure
to radiotherapy, tumors, granulomatous diseases or NLDO
after a history of facial trauma; and cases in which other
anomalies were found in the nasal fossa requiring additional
interventions, such as obstructive septal deviations, polyps
and exuberant concha bullosa, since additional procedures
could interfere with the surgical complications. All patients
underwent an initial ophthalmological assessment and an EX-
DCR versus TC-DCR was chosen according to the surgeon’s
experience and/or patient preference.All EX-DCR were
performed exclusively by ophthalmologists and TC-DCR by a
team of ophthalmologists and otorhinolaryngologists. The data
were collected 6 to 8 months after the surgical intervention, in
a follow-up consultation, and anatomic patency as confirmed
by lacrimal irrigation. For all patients, the following data were
collected: age, symptoms reported by patients (excessive
tearing, blurred vision, recurrent eye inflammation with
redness of the eye, recurrent eye infection with mucus or pus
discharge, painful swelling near the inside corner of the eye),
laterality (unilateral or bilateral), type of surgery (EX-DCR or
TC-DCR), subjective outcome (classified as no improvement,
satisfactory improvement or total resolution), need for review
surgery (and surgical technique applied in surgical review) and
major/minor surgical complications. The primary end point was
surgical success, comparing the results obtained using the EX-
DCR technique and TC-DCR technique. As we know, even with
high-grade strictures confirmed by physical examination and
imaging studies, the patient may have no significant epiphora
complaints, or the opposite scenario can also be observed,
where slight obstructions cause a very unpleasant epiphora for
the patients. Therefore, in this study, despite the assessment
of lacrimal pathway patency in an objective way in pre and
postoperative consultations, we chose to emphasize the
subjective outcome, in other words, patient satisfaction. We
define as surgical success a “total resolution” or “satisfactory
improvement” of complaints. When the resolution was not
total, but the participants manifest a significant improvement
and that they did not consider the remaining symptoms
significant to require a new surgical intervention, we classify
as “satisfactory improvement”. If patients showed partial
resolution, but still uncomfortable and with complaints, the
result was not included in cases of surgical success, being
classified as “no improvement”. Secondary end point included ARTIGO ORIGINAL ORIGINAL ARTICLE
the surgical success rate of DCR between two different age
groups: <65 years versus ≥ 65 years. Therefore, the rate of
predefined major and minor complications also was evaluated;
these included as minor complications: slight bleeding, stent
displacement, synechiae in the middle meatus, emphysema in
the medial canthus of the eye, skin scar infection, adherence
of the tear points, canaliculitis/conjunctivitis; and as major
complications: death, vision loss, hemorrhage requiring
intervention, and adverse event requiring hospitalization for
any reason within 1 month after surgery. The surgical review
was performed when there is no improvement or partial
improvement, but not significant, remaining uncomfortable
lacrimal irrigation and whenever necessary an imaging study.
Data collection was performed using Microsoft Excel 2019,
and subsequently treated statistically using IBM SPSS Statistics
version 25. Continuous variables were presented as mean ±
standard deviation, while categorical data were represented
as numbers and percentages. Categorical variables were
compared between groups using the Pearson chi-square test,
thus applied in the evaluation of the subjective surgical success
between TC-DCR versus EX-DCR and to compare the surgical
success between the two different age groups: <65 years versus
≥ 65 years. All differences associated with a chance probability
of 0.05 or less were considered statistically significant.
RESULTS
Between January 2014 and December 2019, and after applying
the inclusion and exclusion criteria, 258 participants (301 eyes)
were included in our study. The following data - demographic
data, symptoms, and laterality of the pathology - are detailed in
table 1. Most participants were ≥ 65 years old (155 participants)
and 103 cases were under 65 years old. Overall, 78.7% were
female (n = 203) and the remaining 21.3% (n = 55) were male,
with a ratio of about 4 women affected by each man (4:1). This
difference in relation to gender was greater when observed in
particular the group with < 65 years old (7:1), and smaller in the
group with ≥ 65 years old (3:1).
Some patients had more than one complaint prior to surgery, the
three most frequent of which were: excessive tearing (88.8%);
recurrent eye inflammation (22.1%); recurrent eye infection
with pus discharge (9.7%). Thus, 301 eyes of 258 participants
underwent surgery. The following data regarding the success
rates between the two evaluated techniques are specified in
the table 2. One hundred and twenty-two EX-DCR and 179 TC-
DCR were performed. In the group of participants submitted
to EX-DCR, a total resolution/satisfactory improvement of the
symptoms was observed in 90.9% of the cases; the remaining
cases that underwent TC-DCR, a total resolution/satisfactory
improvement of complaints was reported in 92.2% of the cases.
No statistically significant difference was found between the two
techniques in terms of the success rate of surgery (p=0.712). In
the group of participants over 65 years of age, the success rate
on EX-DCR was 89.5% and on the TC-DCR 87.7%, lower than
those observed in the study population under 65 years (93.3%
and 97.5%, respectively), and with a statistically significant
difference (p=0.021). In relation of surgical complications,
regardless of the age group, no major complications were
found in the intra and postoperative period. In relation to minor
complications, these were observed in 15.6% of the cases
(Figure 2). In 7 cases, intraoperative hemorrhage was observed
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