Page 22 - Revista SPORL - Vol 58. Nº1

the classical approach first, to be able to use it in the case of
intraoperative complications, and the laser must be handled
carefully. The costs of this procedure are also higher when
compared to classic surgery.
On the other hand, TC-DCR is a minimally invasive surgical
procedure, having the advantage of accessing the operating
field through anatomic pathways (the lacrimal canaliculus). This
contributes greatly to minimizing trauma to the surrounding
tissue and avoiding unnecessary surgical skin scars. It is also
important to highlight the shorter surgery time25 and lower
blood loss. TC-DCR also plays an important role in surgical
revision, namely surgical revisions of the EX-DCR technique.
As it is a less invasive procedure, with less surgical time, and
with success rates comparable to those observed in EX-DCR, it
makes this surgical approach possible and safe in older patients
with systemic problems.Even more, because it is performed by
ophthalmologists and otolaryngologists together, it is possible
to correct multiple obstructions at different levels of the lacrimal
pathway and concomitant ophthalmological pathologies that
contribute to the worsening of the epiphora, often present in
the older population.
Summing up, the population over 65 years old is a special
population, with a higher probability of multifactorial pathology
of the lacrimal system, obstruction at multiple levels of the
lacrimal pathway and more severe obstruction, as well as a
greater number of comorbidities and polypharmacy.
However, epiphora can have a significant negative impact on
quality of life and should not be neglected in this particular
population.
Since success rates are high and with few major complications,
DCR is an option after medical treatment fails. The TC-DCR
presents success rates similar to those observed in the EX-DCR,
with important advantages in the elderly population and, as
such, it must be one of the main techniques to be considered in
this population, associated with other procedures to approach
the proximal lacrimal pathway when required.
The study we carried out has some limitations, starting with
being a retrospective study and all the limitations that arise
from it. It is important to note that: (1) only subjective functional 2014;42:284–7. doi: 10.1111/ceo.12161
improvement was evaluated, and the elderly population may
be less demanding in the final result, and thus change the
success rates reported; (2) results between 6 to 8 months
after surgery may differ from more long-term results; (3) the
distribution by the EX-DCR versus TC-DCR group was non-
random, having been according to the surgeon’s experience or
the patient’s preference, without well-defined criteria; (4) in
some patients, other associated pathologies such as changes in
the production of tears and changes in the pump mechanism,
are more frequently present in the elderly population and these
concomitant disorders can compromised the success rates; (5)
no standardized questionnaire was applied for the subjective
evaluation of surgical success.
CONCLUSION
Studies showed that the success rates of DCR vary between
80% to 100%, similar to that observed in our study (91.7%),
with no significant difference between the two techniques (EX-
DCR versus TC-DCR). Regarding the two age groups evaluated,
the success rate for the population with ≥ 65 years varied in the
interval between 87.7% and 89.6%, according to the different
techniques, that are actually lower than those observed in the
younger population, which varied between 93.3%-97.5%, and
20 REVISTA PORTUGUESA DE OTORRINOLARINGOLOGIA E CIRURGIA DE CABEÇA E PESCOÇO
this difference was statistically significant. However, in the older
population the values remain high, close to those observed in
the younger population, and without further complications.
Conflict of interests
The authors declare that they have no conflict of interest
regarding this article.
Data confidentiality
The authors declare that they followed the protocols of their
work in publishing patient data.
Protection of people and animals
The authors declare that the procedures followed are in
accordance with the regulations established by the directors
of the Commission for Clinical and Ethical Research and in
accordance with the Helsinki Declaration of the World Medical
Association.
Privacy policy, informed consent and Ethics Committee
Authorization
The authors declare authorization by Ethics Committee to carry
out this study and they have written consent for the use of
photographs of patients in this article.
Financing
This work did not receive any contribution, funding or
scholarship.
Availability of scientific data
There are no publicly available data sets related to this work.
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