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

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.