title: Comparing outcomes of pediatric and adult external dacryocystorhinostomy in Nepal: Is age a prognostic factor?
abstract: We determine whether age is a prognostic factor for surgical outcomes of external dacryocystorhinostomy (Ex-DCR). This retrospective cohort study conducted at Tilganga Institute of Ophthalmology (Kathmandu, Nepal) compared pediatric Ex-DCR procedures (age ≤ 15 years) to adult Ex-DCR procedures (age > 15 years) and was performed between January 2013 and December 2013, with a minimum follow-up period of 6 months. Primary outcome measure was rate of success, defined as complete resolution of subjective symptom(s) of epiphora (subjective success), combined with patent lacrimal passage on syringing (anatomical success) at last follow-up visit. Other outcome measures included clinical presentation, diagnosis, intraoperative complications and post-operative complications. In total, 154 Ex-DCR procedures were included, with an age range of 8 months to 81 years (mean age 36.4 ± 21.0 years). In all, 38 pediatric Ex-DCR procedures were compared to 116 adult procedures. Success rates were 97% in the pediatric group and 95% in the adult group, with no clinically or statistically significant difference in success rate or complication rate between groups (p > 0.05). Our study yielded high success rates of Ex-DCR in both pediatric and adult age groups suggesting that Ex-DCR remains an optimal treatment choice for all age groups. With no difference in surgical outcomes between pediatric and adult patients, including complication rate, we conclude that age is not a prognostic factor for Ex-DCR failure. We do not recommend adjuvant therapy for pediatric patients.
authors.affiliation: a Department of Ophthalmology , Tilgnanga Institute of Ophthalmology , Kathmandu , Nepal.
authors.forename: Ben
authors.initials: B
authors.lastname: Limbu
authors.affiliation: b Department of Ophthalmology , Rapti Eye Hospital , Dang , Nepal.
authors.forename: Sulaxmi
authors.initials: S
authors.lastname: Katwal
authors.affiliation: c Department of Ophthalmology , Prince of Wales Hospital , Sydney , Australia.
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Lim
authors.affiliation: d College of Medicine , Ohio State University , Columbus , Ohio , USA.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Faierman
authors.affiliation: e Moran Eye Center , University of Utah Health Center , Salt Lake City , Utah , USA.
authors.forename: Anna G
authors.initials: AG
authors.lastname: Gushchin
authors.affiliation: a Department of Ophthalmology , Tilgnanga Institute of Ophthalmology , Kathmandu , Nepal.
authors.forename: Rohit
authors.initials: R
authors.lastname: Saiju
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003608:Dacryocystorhinostomy / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications; D007767:Lacrimal Duct Obstruction / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000503:physiopathology / Q000601:surgery*; D009390:Nepal; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies
keywords: Age; DCR; external dacryocystorhinostomy; lacrimal surgery; pediatric