Antimetabolites as an adjunct to dacryocystorhinostomy for n | Figure 1

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Antimetabolites as an adjunct to dacryocystorhinostomy for nasolacrimal duct obstruction

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What is the aim of the review?

Dacryocystorhinostomy (DCR) is a type of surgery that creates a new tear drainage pathway between the eyelid and nose to relieve tearing symptoms (functional success), improve openness of the tear duct to irrigation (anatomic success), and increase the size of the opening into the nose (ostium size). Our aim was to assess whether antiscarring medications (antimetabolites) can increase the functional success, anatomic success, and ostium size of DCR.

Key results

We found that antimetabolites may improve functional and anatomic success (relative to DCR alone) at a follow‐up time longer than six months. Antimetabolites may also improve ostium size at six months.

What was studied in the review?

The lacrimal system of the eye produces tears, which nourish the eye surface and keep it moist. After passing along the eye surface, tears drain into the nose through the lacrimal drainage apparatus. Nasolacrimal duct obstruction (NLDO) is the blockage of this canal, which can cause an overflow of tears. NLDO is usually painless and can affect one or both eyes. NLDO can also lead to infection of the eye. NLDO is treated surgically with a procedure known as dacryocystorhinostomy (DCR), which establishes a new pathway by creating a pathway between the tear sac and the nose. Antimetabolites have been used to improve success rates of this procedure. We wanted to learn whether DCR in combination with antimetabolites can improve outcomes for functional success, anatomic success, and ostium size than DCR alone. We collected and analyzed all relevant randomized controlled trials to answer this question.

What are the main results of the review?

We identified 31 relevant studies for inclusion, most of which originated in South and East Asia and involved predominantly women. These studies compared participants who underwent DCR with metabolites versus participants who underwent DCR alone. Twenty‐three of these studies (1309 participants) provided data on our outcomes of interest.

DCR with antimetabolites may improve functional and anatomic success when patients are followed more than six months after surgery; the certainty of this evidence was moderate. There was no difference in functional and anatomic success at six months among participants who underwent DCR with antimetabolites compared to participants who underwent DCR alone; the certainty of evidence is low.

At six months, participants who underwent DCR with antimetabolites may have increased ostium size compared to those receiving DCR alone. However, beyond six months, there is no evidence of a difference between participants who underwent DCR with antimetabolites compared to participants who underwent DCR alone. The certainty of the evidence was low due to substantial variability among the studies that assessed this outcome. Adverse effects of antimetabolites were minimal.

How up‐to‐date is this review?

We reviewed studies published up to 6 September 2019.

Read the full Cochrane Review here

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