Original Article
Meta-analysis of randomized controlled trials in dacryocystorhinostomy with and without silicone intubation

https://doi.org/10.1016/j.jcjo.2017.12.006Get rights and content

Abstract

Objective

To determine the effect of bicanalicular silicone intubation (SI) on dacryocystorhinostomy (DCR) success rate in adult primary acquired nasolacrimal duct obstruction.

Design

Meta-analysis of randomized controlled trials (RCTs).

Methods

PubMed, Embase, Cochrane CENTRAL, Ovid Medline, Google Scholar, and grey literature search was performed from inception to June 2017. All prospective DCR trials with randomization of SI were considered. Cases with non-SI or adjunctive mitomycin were excluded. Where possible we analysed only 1 eye from each subject. Random effects meta-analysis was performed.

Results

We retrieved 1142 articles and after filtering there were 14 RCTs with a total of 1311 DCR cases. There were 444 external DCRs and pooled estimate showed risk ratio (RR) was 1.08 (95% confidence interval [CI] 1.01–1.15). There were 867 predominantly endonasal DCR with RR 1.04 (95% CI 0.99–1.09). When all DCR modalities were combined the RR was 1.05 (95% CI 1.01–1.09).

Conclusions

Overall, there was a 5% statistically significant improvement in DCR success rate with SI, but more endonasal DCR RCTs are required.

RÉSUMÉ

Objet

Déterminer l’effet de l’insertion de sondes en silicone (intubation bicanaliculaire) sur le taux de réussite de la dacryocystorhinostomie (DCR) dans le traitement de la dacryosténose primitive acquise de l’adulte.

Nature

Méta-analyse d’essais comparatifs randomisés

Méthodes

On a effectué une recherche de tous les articles publiés dans PubMed, Embase, Cochrane CENTRAL, Ovid Medline, Google Scholar et la littérature grise jusqu’en juin 2017. Tous les essais prospectifs portant sur la DCR avec intubation aléatoire ont été examinés. Les cas ne faisant pas appel à l’intubation, ainsi que ceux comportant l’administration adjuvante de mitomycine, ont été exclus. Dans la mesure du possible, on n’a analysé qu’un seul œil chez chaque patient. Il s’agissait d’une méta-analyse à effets aléatoires.

Résultats

Après filtration des 1142 articles extraits, on a retenu 14 essais comparatifs randomisés (ECR) comptant 1311 cas de DCR. De ceux-ci, 444 étaient des DCR externes; selon l’estimation des résultats groupés, le risque relatif (RR) était de 1,08 (intervalle de confiance [IC] à 95 %: 1,01–1,15). Les 867 autres étaient surtout des DCR endonasales (RR de 1,04; IC à 95 %: 0,99–1,09). Le RR global (tous types de DCR confondus) était de 1,05 (IC à 95 %: 1,01–1,09).

Conclusions

Dans l’ensemble, on a constaté une amélioration statistiquement significative – de 5 % – du taux de réussite de la DCR avec l’intubation, mais la tenue d’autres ECR sur la DCR endonasale s’impose.

Section snippets

Methods

The present meta-analysis considered only prospective clinical trials of primary DCR where the decision whether or not to silicone intubate was randomized. All subjects were older than 16 years. External, endonasal, and laser-assisted DCR modalities were included. Only English language articles were used.

We searched for articles, abstract reports, conference abstracts, and conference reports on Embase, PubMed, Ovid Medline, the Cochrane Central Register of Controlled Trials, Google Scholar,

Results

The study flow chart (Fig. 1) outlines the 1142 studies that were filtered to 14 RCTs.2, 3, 4, 10, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22 The 1311 DCR cases from these RCTs are summarized in Table 1.

This study analyses 1311 DCR cases from RCTs and provides adequate power to reach a conclusion, based on the sample size estimation for binary outcome parallel group superiority trials. Using a = 0.05 and power (1 − β) = 0.8, and an 87% overall success rate for DCR derived from Huang’s meta-analysis,

Conclusions

A 2017 meta-analysis of 12 RCTs with and without SI, comprising 969 DCR cases, suggested that there was a statistically significant benefit for external DCR,8 but not endonasal DCR. The aforementioned study had mislabelled forest plots, had incorrectly included a study with using a mitomycin nonstent control group,9 and was published before 3 endonasal DCR RCTs13, 21, 22 became available in 2016. Our study incorporated 14 RCTs and 1311 DCR cases.

The main limitation of our meta-analysis is the

Disclosure

The authors have no proprietary or commercial interest in any materials discussed in this article.

References (26)

  • C. Xie et al.

    Comparing the success rate of dacryocystorhinostomy with and without silicone intubation: a trial sequential analysis of randomized control trials

    Sci Rep

    (2017)
  • R. Dogan et al.

    Diode laser-assisted endoscopic dacryocystorhinostomy: a comparison of three different combinations of adjunctive procedures

    Eur Arch Otorhinolaryngol

    (2013)
  • S. Elmorsy et al.

    Rubber tube versus silicone tube at the osteotomy site in external dacryocystorhinostomy

    Orbit

    (2010)
  • Cited by (18)

    View all citing articles on Scopus
    View full text