title: A systematic review of outcomes after dacryocystorhinostomy in adults.
abstract: BACKGROUND
  This study was designed to systematically review the clinical outcomes of dacryocystorhinostomy (DCR) surgery. Data sources included PubMed for English language literature from January 1966 to December 2008 combined with a manual review of citations within article bibliographies.
  
  
  METHODS
  Citations acquired from the targeted search were filtered independently by two researchers. Relevant articles were reviewed to obtain information including interventions and outcome measures. The surgical techniques were categorized into external DCR (EX-DCR), endonasal laser-assisted DCR (LA-DCR), and nonlaser endoscopic endonasal DCR techniques (EN-DCR). Articles were then assigned level-of-evidence grades as defined by the Oxford Center for Evidence-Based Medicine.
  
  
  RESULTS
  A total of 73 studies that fulfilled the inclusion criteria were analyzed. Of these, 68 were graded as level 4, 11 were graded as level 3b, and 1 was graded at level 2b evidence. A total of 4800 patients were pooled, from which 4921 DCRs were performed. All studies reported success during the follow-up period, although the outcome measures used were not consistent in the studies. Success varied between 65 and 100% after EX-DCR compared with EN-DCR, which varied from 84 to 94%. The success rate of LA-DCR varied widely between 47 and 100%. There was low evidence base to support the use of silicone stent to improve surgical success. Most studies did not show significantly improved outcomes with an antimetabolite. The overall intra- and postoperative complication rates were 1.0 and 6%, respectively.
  
  
  CONCLUSIONS
  DCR is an effective and safe method for the treatment of nasolacrimal obstruction. Meta-analysis of outcomes was not feasible because of the heterogenous patient groups and outcome measures used. Nonetheless, the literature provides considerable levels 3 and 4 evidence to support DCR surgery in adults. Outcomes after EN-DCR and EX-DCR were comparable. The failure rate for LA-DCR was higher.
authors.affiliation: Common Cold Center, Cardiff School of Biosciences, Cardiff University, Cardiff, United Kingdom. samuel.leong@nhs.net
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Leong
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Macewen
authors.forename: Paul S
authors.initials: PS
authors.lastname: White
mesh_terms: D000328:Adult; D003608:Dacryocystorhinostomy / Q000295:instrumentation / Q000379:methods*; D004724:Endoscopy; D019317:Evidence-Based Medicine; D006287:Health Planning Guidelines; D006801:Humans; D011183:Postoperative Complications; D015607:Stents; D016896:Treatment Outcome