Page 21 - Revista SPORL - Vol 58. Nº1

FIGURE 2
Bar graphic with surgical minor complications distribution
fact that inflammatory processes in the tear pathway, changes
in the production of tears and changes in the pump mechanism
are chronic inflammatory and degenerative processes that
happen over the years, affecting both genders, reducing the
difference found in the younger groups. EX-DCR is considered
the gold standard treatment in the management of NLDO. The
success rate in many recent series exceeds that obtained in
previous reports, and in many cases it approaches the values
of 90-95% achieved with the EX-DCR17,18. In the series by Onerci
et al. in 2000, with 108 surgeries, a success rate of 94% was
obtained, a value close to 92% of the series published in 2007
by Yigit et al., with 49 surgeries19,20.However, following the
technical increase of the last decades in nasal endoscopic
and laser/fiber optic surgery, TC-DCR has been the target of
growing interest, which is reflected in the results obtained.
Some studies have reported a higher success rate with EX-DCR
compared to TC-DCR21,22. However, other studies have shown
similar success rates. Nuhoglu F et al.23 found out that there was with more uncomfortable symptoms may be willing to undergo
91.8% success rate in TC-DCR group and Suranagi MD et al.24
found out in their study that success rate was 93.4% in EX-DCR
and 92.2% in TC-DCR, that is, high and very close values. In our
study, the success rate in the EX-DCR was 90.9% and in the TC-
DCR was 92.2%, values that were close to the values reported in
the literature, and no significant difference was found between
techniques.Furthermore, there are few studies in the literature
dedicated particularly to the older population, but success rates
for DCRs in the order of 64% have been suggested13. In our
study, the success rate for the population with ≥ 65 years varied
in the interval, according to the different techniques, between
87.7% and 89.6% values (TC-DCR and EX-DCR, respectively)
that are actually lower than those observed in the younger
population, which varied between 93.3%-97.5% (EX-DCR and
ARTIGO ORIGINAL ORIGINAL ARTICLE
TC-DCR, respectively), and this difference being significant.
However, in the older population the values remain high, close
to those observed in the younger population, and apparently
without further complications. In fact, regarding complications,
and in both surgical techniques evaluated, there were no
major complications, even in the older group, suggesting that
it is a safe surgical procedure. Minor complications were also
similar in the two age groups assessed.However, the geriatric
population is still an additional challenge when the goal is to
treat lacrimal pathology:
(1) they present multifactorial pathology of the lacrimal
system, leading to other non-surgical causes of persistence of
the epiphora: eyelid pathology; dry eye syndrome with reflex
tearing - changes in the production of tears and functional
changes in the tear pathway (pump mechanism);
(2) Increased likelihood of tearing obstruction at multiple levels;
(3) Higher probability of severe pathology: elderly patients
surgery, while those with mild symptoms may be more likely to
refuse surgical treatment.
EX-DCR has some disadvantages, such as cutaneous scarring,
disruption of medial canthus anatomy, more difficult surgical
review, duration of surgery and excessive intraoperative
bleeding. But the EX-DCR also has some advantages, such
as the direct observation of the lacrimal pathway (allowing
the diagnosis of other pathologies such as tumors and
granulomatous diseases, allowing the sending of material for
pathological anatomy), it is a cheap procedure and the surgeons
are familiar with.
In turn, TC-DCR, a more recent technique, has few studies in the
literature regarding its long-term effectiveness. Furthermore,
as in all endoscopic surgeries, the surgeon must have mastered
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