Scolaris Content Display Scolaris Content Display

Cochrane Database of Systematic Reviews

Dacriocistorrinostomía endonasal versus externa para la obstrucción del conducto nasolagrimal

Información

DOI:
https://doi.org/10.1002/14651858.CD007097.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 24 febrero 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Salud ocular y de la visión

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

Altmetric:

Citado por:

Citado 0 veces por enlace Crossref Cited-by

Contraer

Autores

  • Lona Jawaheer

    Correspondencia a: Ophthalmology Department, Gartnavel General Hospital, Glasgow, UK

    [email protected]

    [email protected]

  • Caroline J MacEwen

    Department of Ophthalmology, Ninewells University Hospital, Dundee, UK

  • Deepa Anijeet

    Ophthalmology Department, Gartnavel General Hospital, Glasgow, UK

Contributions of authors

Conceiving the review: Cochrane Eyes and Vision

2011 version

  • Designing the review: DA

  • Co‐ordinating the review: DA

  • Data collection for the review

    • Designing electronic search strategies: Cochrane Eyes and Vision Group Trials Search Co‐ordinator

    • Undertaking manual searches: DA

    • Screening search results: DA, LD

    • Organising retrieval of papers: DA, LD

    • Screening retrieved papers against inclusion criteria: DA, LD

    • Appraising quality of papers: DA, LD

    • Extracting data from papers: DA, LD

    • Writing to authors of papers for additional information: DA

    • Providing additional data about papers: DA

    • Obtaining and screening data on unpublished studies: DA

  • Data management for the review:

    • Entering data into RevMan: DA, LD

    • Analysis of data: DA, LD

  • Interpretation of data

    • Providing a methodological perspective: DA, CJM

    • Providing a clinical perspective: DA, CJM

    • Providing a policy perspective: DA, CJM

    • Providing a consumer perspective: DA, CJM

  • Writing the review: DA, LD, CJM

  • Providing general advice on the review: CJM

2017 update

LJ and DA screened the search results, extracted data, assessed studies for bias and wrote to trial investigators for additional information. CJM provided general advice on the review. LJ wrote the text for the update of the review.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • National Institute for Health Research (NIHR), UK.

    • Richard Wormald, Co‐ordinating Editor for Cochrane Eyes and Vision (CEV) acknowledges financial support for his CEV research sessions from the Department of Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital National Health Service (NHS) Foundation Trust and UCL Institute of Ophthalmology for a Specialist Biomedical Research Centre for Ophthalmology.

    • The NIHR also funds the CEV Editorial Base in London.

    The views expressed in this publication are those of the authors and not necessarily those of the NIHR, NHS, or the Department of Health.

Declarations of interest

Lona Jawaheer: none known
Caroline MacEwen: none known
Deepa Anijeet: none known

Acknowledgements

Cochrane Eyes and Vision created and executed the search strategies. We thank Catey Bunce and Daniel Morris for their comments, and Iris Gordon for her assistance with searches and obtaining articles. We also thank Anupa Shah and Jennifer Evans for author support, and Gianni Virgili for his help with statistical analysis.

We are also grateful to Hsin‐wen Wu for translating Chinese reports of trials.

Version history

Published

Title

Stage

Authors

Version

2017 Feb 24

Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction

Review

Lona Jawaheer, Caroline J MacEwen, Deepa Anijeet

https://doi.org/10.1002/14651858.CD007097.pub3

2011 Jan 19

Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction

Review

Deepa Anijeet, Lynne Dolan, Caroline J MacEwen

https://doi.org/10.1002/14651858.CD007097.pub2

2008 Apr 23

Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction

Protocol

Deepa Anijeet, Lynne Dolan, Caroline J MacEwen

https://doi.org/10.1002/14651858.CD007097

Differences between protocol and review

We prepared a 'Summary of findings' table and a GRADE assessment which was an amendment to the protocol (Anijeet 2008).

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Endonasal versus external DCR, Outcome 1 Anatomic success.
Figuras y tablas -
Analysis 1.1

Comparison 1 Endonasal versus external DCR, Outcome 1 Anatomic success.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Endonasal versus external DCR, Outcome 2 Subjective success.
Figuras y tablas -
Analysis 1.2

Comparison 1 Endonasal versus external DCR, Outcome 2 Subjective success.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Endonasal versus external DCR, Outcome 3 Intraoperative bleeding.
Figuras y tablas -
Analysis 1.3

Comparison 1 Endonasal versus external DCR, Outcome 3 Intraoperative bleeding.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Endonasal versus external DCR, Outcome 4 Postoperative bleeding.
Figuras y tablas -
Analysis 1.4

Comparison 1 Endonasal versus external DCR, Outcome 4 Postoperative bleeding.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Endonasal versus external DCR, Outcome 5 Wound infection/gaping.
Figuras y tablas -
Analysis 1.5

Comparison 1 Endonasal versus external DCR, Outcome 5 Wound infection/gaping.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Endonasal dacryocystorhinostomy (DCR) compared with external DCR for nasolacrimal duct obstruction

Patient or population: People with nasolacrimal duct obstruction

Settings: Hospital

Intervention: Endonasal DCR

Comparison: External DCR

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of Participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Assumed risk1

Corresponding risk

External DCR

Endonasal DCR

Anatomic success

(i.e. patent lacrimal passage after a period of at least six months after operation)

900 per 1000

Laser‐assisted endonasal DCR

⊕⊝⊝⊝
VERY LOW2,3,4

621 per 1000 (468 to 828)

RR 0.69 (0.52 to 0.92)

64

(1)

Mechanical endonasal DCR

900 per 1000 (729 to 1000)

RR 1.00 (0.81 to 1.23)

40
(1)

Subjective success

(i.e. resolution of symptoms of watering following surgery)

840 per 1000

Laser‐assisted endonasal DCR5

⊕⊕⊝⊝
LOW2,3

588 per 1000 (428 to 815)

RR 0.70 (0.51 to 0.97)

64

(1)

Intraoperative bleeding

170 per 1000

Laser‐assisted endonasal DCR

⊕⊝⊝⊝
VERY LOW2,3,6

No cases of intraoperative bleeding reported in trial of laser‐assisted endonasal DCR

Not estimable

Not estimable

64

(1)

Mechanical endonasal DCR

170 per 1000 (85 to 337)

RR 1.00 (0.50 to 1.98)

40

(1)

Postoperative bleeding

40 per 1000

13 per 1000 (2 to 124)

RR 0.33 (0.04 to 3.10)

104

(2)

⊕⊝⊝⊝
VERY LOW2,7

Wound infection/gaping

40 per 1000

Laser‐assisted endonasal DCR

⊕⊝⊝⊝
VERY LOW2,7

No cases of wound infection/gaping reported in trial of laser‐assisted endonasal DCR

Not estimable

Not estimable

64

(1)

Mechanical endonasal DCR

8 per 1000 (0 to 157)

RR 0.20 (0.01 to 3.92)

40

(1)

CI: confidence interval; DCR: dacryocystorhinostomy; RR: risk ratio

GRADE Working Group grades of evidence
High‐certainty: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate‐certainty: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low‐certainty: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low‐certainty: We are very uncertain about the estimate.

1The assumed control risk was estimated from the control group in the included studies.
2We downgraded one level for study limitations because the methods used for random sequence generation, allocation concealment and masking were not clearly described.
3We downgraded one level for imprecision because the number of participants enrolled in these trials was low and the estimate of effect was imprecise.
4We downgraded one level for inconsistency as there was clinical and statistical heterogeneity in the two trials (test for interaction P = 0.04).
5Subjective success was not reported in the trial of mechanical endonasal DCR (Moras 2011).
6We downgraded one level for inconsistency as there was clinical heterogeneity in the two trials. There were no cases of intraoperative haemorrhage in the trial of laser‐assisted endonasal DCR.
7We downgraded two levels for imprecision as there were only two events recorded, both in the external DCR group.

Figuras y tablas -
Ir a la tabla de la revisión
Comparison 1. Endonasal versus external DCR

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Anatomic success Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Laser‐assisted

1

64

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.52, 0.92]

1.2 Mechanical

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.81, 1.23]

2 Subjective success Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 Intraoperative bleeding Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 Laser‐assisted

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 Mechanical

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Postoperative bleeding Show forest plot

2

104

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.04, 3.10]

4.1 Laser‐assisted

1

64

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.89]

4.2 Mechanical

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.72]

5 Wound infection/gaping Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

5.1 Laser‐assisted

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 Mechanical

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 1. Endonasal versus external DCR
Ir a la tabla de la revisión