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

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.