The incidence of acquired nasolacrimal duct obstruction (NLDO) increases with age. Dacryocystorhinostomy, the definitive treatment for NLDO, has a high success rate with a low complication rate overall, but surgical outcomes have not been reported specifically for an older adult population.
"Multiple factors confer an increased surgical risk on older patients, who as a group receive the highest number of surgical procedures. We wondered whether older patients treated for NLDO may be at increased risk of intraoperative and postoperative complications," says Elizabeth A. Bradley, M.D., with Ophthalmology at Mayo Clinic's campus in Rochester, Minnesota. "There is a need for data to assess outcomes of surgery in this age group."
Dr. Bradley and a research team examined surgical outcomes and complication rates of dacryocystorhinostomy in a retrospective study of patients age 80 and older who were treated with external dacryocystorhinostomy at Mayo Clinic between Jan. 1, 1990, and Dec. 31, 2010. The team then compared outcomes with a matched control group of patients ages 40 to 79 who were treated with external dacryocystorhinostomy by the same surgeon within 12 months of their paired older adult patient.
Data abstracted from patient medical records included symptomatic relief and complications such as tube protrusion, infection, persistent bleeding and return to operating room. The primary endpoint was complete or substantial resolution of presenting symptoms at the time of last follow-up. Secondary endpoints included anatomic patency, adverse event rate and return to operating room within one month of surgery.
In the older adult group, 32 patients underwent 42 dacryocystorhinostomies; in the control group, 63 younger patients underwent 73 dacryocystorhinostomies. Comparative results include the following:
- Resolution of symptom rate at last follow-up was 64 percent in the older adult group versus 86 percent in the younger group (P = 0.02).
- Although there was no difference between groups with respect to common postoperative complications, there was a higher rate of serious complications in the older adult group (five events versus one event; P = 0.01).
- There was no difference between groups regarding need for additional eyelid surgery (P = 0.30).
"Although most older patients experienced symptom resolution after dacryocystorhinostomy, the rate of symptom resolution was significantly lower than that of younger patients," says Dr. Bradley. "The risk of routine complications was similar between groups, but the risk of serious complications was higher in the older group.
"Over the last half-century, the number of people older than 65 years has tripled worldwide. The population comprising those 85 and older is projected to more than triple by 2060. Consideration of individual patient symptoms in the context of medical comorbidities, combined with discussion of the potential benefits and risks of surgical intervention, may allow more effective counseling of older patients who are considering dacryocystorhinostomy surgery."
Study results were published in Ophthalmology in 2017.
For more information
Tooley AA, et al. Dacryocystorhinostomy for acquired nasolacrimal duct stenosis in the elderly (≥ 80 years of age). Ophthalmology. 2017;124:263.