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PURPOSE: To evaluate the effect of mitomycin-C (MMC) on the success of external (Ex-DCR) or endoscopic dacryocystorhinostomy (En-DCR). METHOD: A systematic review of randomized clinical trials of Ex- or En-DCR with and without the use of MMC to treat primary acquired nasolacrimal duct obstruction (NLDO) was done. Two authors independently searched six databases from 1990 to 2019, using the terms "dacryocystorhinostomy" and "mitomycin-C." Statistical and meta-analyses were performed using RevMan 5.3 software. RESULTS: Twenty-seven studies involving 2158 surgeries were included in this systematic review. The Ex-DCR group comprised 14 studies [odds ratio (OR): 2.74; 95% confidence intervals (CI) 1.54-4.87; I2 = 30%], while the En-DCR group 13 studies (OR: 1.69; 95% CI 1.21-2.37; I2 = 0%). The use of MMC slightly increased the success rate of Ex- or En-DCR (OR: 2.1; 95% CI 1.52-2.9; I2 = 14%). CONCLUSION: The intraoperative use of MMC is safe and slightly improves the success rate of Ex- or En-DCR. However, the evidence was very weak.
ABSTRACT
Aim: To compare external dacryocystorhinostomy (DCR) and endoscopic approaches in terms of success rate and complications. Methods: In this randomized, interventional, comparative study, ninety-four patients (108 surgeries) participated in this study, 58 cases of endoscopic dacrocystorhinostomy and 50 cases of conventional external dacrocystorhinostomy were performed between December 2013 and December 2016 in the Ophthalmology department and in association with the Otorhinolaryngology department in "Diwaniya" teaching hospital in Iraq. All the patients had detailed general medical and ocular history, and they also underwent ocular and ENT examinations to exclude any nasal pathology. The level of blockage was diagnosed by lacrimal syringing and probing. Surgery was done under general anesthesia using a hypotensive technique in all patients, and the surgical outcomes and both intra and post-operative complications were analyzed. Results: Ninety-four patients (32 males and 62 females; mean age, 56 years) underwent 108 dacrocystorhinostomy surgeries for acquired Nasolacrimal duct obstruction. The success rate associated with the endoscopic procedure was higher than that associated with the external approach [53 (91.4%) versus 41 (82.0%)]; however, the difference was not statistically significant (p=0.148). Moreover, the success rate was even better following revision in both surgical procedures [55 (94.8%) versus 42 (84.0%)] and was much better with endoscopic type and showing a nearly significant value (P=0.064). The odds ratio and 95 % confidence interval were 3.49 and (0.87-13.97), respectively, which seems to demonstrate that endoscopic surgery is associated with approximately 3.5 times better successful rate in comparison with open surgery. The patients that wished to perform surgical intervention for the other eye were associated significantly more with the endoscopic procedure compared with the open procedure [54 (93.1%) vs. 40 (69.0%), respectively, (P=0.043), OR=3.38, 95% CI (0.99-11.54)] Conclusion: The endoscopic approach offered a better operation success rate for acquired Nasolacrimal duct obstruction compared with an external approach
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Humans , Adolescent , Adult , Middle Aged , Dacryocystorhinostomy/methods , Retrospective Studies , Endoscopy/methods , Lacrimal Duct ObstructionABSTRACT
PURPOSE: To evaluate the effect of stents on the success of endoscopic dacryocystorhinostomy (DCR-EN) for treating primary acquired nasolacrimal duct obstruction (NLDO). METHOD: A systematic review of randomized clinical trials of DCR-EN for NLDO comparing outcomes of surgeries performed with and without the use of bicanalicular stents and the complications associated with each procedure. Two authors independently searched six databases (Scopus, PubMed, EMBASE, Google Scholar, Cochrane Central Register of Controlled Trials, and Web of Science) up to May 2019. Statistical analysis and meta-analysis were performed using RevMan 5.3 software provided by the Cochrane Collaboration. RESULTS: Twelve studies involving 997 surgeries were included in this systematic review. The meta-analysis using a fixed-effects model showed a 94% success rate with stents versus 90.6% without stent. Although stent use favors greater success of DCR-EN, the confidence interval (CI) was wide and very close to nullity line (1.01), decreasing the strength of the recommendation for stent (odds ratio: 1.62, 95% CI: 1.01-2.59, I 2 = 0%). Meta-analysis of the adverse effects was not possible. A descriptive analysis was performed of the general complications related to the stents. CONCLUSIONS: There is evidence that the use of bicanalicular stents slightly improves the success rate of DCR-EN, but the quality of evidence is low. Future prospective, randomized trials enrolling larger sample sizes may provide stronger evidence to determine whether the stent use influences the success of primary acquired DCR-EN.