Summary of findings for the main comparison. Mitomycin C dacryocystorhinostomy compared to dacryocystorhinostomy alone for nasolacrimal duct obstruction.
| Mitomycin C dacryocystorhinostomy compared to dacryocystorhinostomy alone for nasolacrimal duct obstruction | ||||||
| Patient or population: nasolacrimal duct obstruction Setting: hospital Intervention: MMC DCR Comparison: DCR alone | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with DCR alone | Risk with MMC DCR | |||||
| Functional success, defined as the relief of epiphora Follow‐up: 6 months |
Study population | RR 1.12 (0.98 to 1.29) | 356 (7 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | ||
| 81 per 100 | 90 per 100 (79 to 100) | |||||
| Functional success, defined as the relief of epiphora Follow‐up: > 6 months | Study population | RR 1.15 (1.07 to 1.25) | 909 (14 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | ||
| 73 per 100 | 84 per 100 (78 to 91) | |||||
| Anatomic success, defined as patency to lacrimal irrigation Follow‐up: 6 months |
Study population | RR 1.02 (0.95 to 1.11) | 306 (4 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | ||
| 87 per 100 | 89 per 100 (83 to 97) | |||||
| Anatomic success, defined as patency to lacrimal irrigation Follow‐up: > 6 months |
Study population | RR 1.09 (1.04 to 1.15) | 831 (12 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | ||
| 82 per 100 | 89 per 100 (85 to 94) | |||||
| Ostium size on nasal endoscopy Follow‐up: 6 months |
The mean ostium size on nasal endoscopy ranged from 7 to 10 mm2. | Point estimates from two studies that reported mean change in ostium size at six months follow‐up. Both studies consistently show that participants treated with MMC are more likely to have larger ostium size in (mean difference (MD) 16.27, 95% CI 11.39 to 21.15; 1 study, 15 participants) and (MD 3.70, 95% CI 2.09 to 5.31; 1 study, 50 participants). | 65 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 3 | As fewer than 10 studies assessed this outcome, publication bias could not be quantitatively assessed, however there may still be some but not very serious publication bias. We did not downgrade the certainty of evidence. | |
| Ostium size on nasal endoscopy at Follow‐up: > 6 months |
The mean ostium size on nasal endoscopy ranged from 2 to 13 mm2. | Beyond 6 months, one study found no evidence a difference in ostium size beyond six months follow up (MD 1.40, 95% CI 0.57 to 2.23; 1 study, 50 participants), and another found that participants who were treated with MMC may experience larger ostium size (MD 8.20, 95% CI 6.14 to 10.26; 1 study 50 participants) | 100 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 3 | As fewer than 10 studies assessed this outcome, publication bias could not be quantitatively assessed, however there may still be some but not very serious publication bias. We did not downgrade the certainty of evidence. | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; DCR: dacryocystorhinostomy; MD: mean difference; MMC: mitomycin‐C; RCT: randomized controlled trial; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High‐certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate‐certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low‐certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low‐certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
1Downgraded (‐1) due to risk of bias. 2Downgraded (‐1) due to imprecision. 3Downgraded (‐1) due to inconsistency.