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Abstract：
BACKGROUND: Epiphora is a common ophthalmologic sign that is most commonly caused by distal acquired lacrimal obstruction. Recent data have demonstrated that external dacryocystorhinostomy (EXT-DCR) and endoscopic endonasal dacryocystorhinostomy (END-DCR) can be considered the treatments of choice. However, different post-surgical medical therapies are available and are currently used to improve surgical outcomes, although no direct comparison has been performed.
OBJECTIVE: To analyse the influence of post-surgical medical treatments on END-DCR and EXT-DCR outcomes.
METHODS: A structured search was conducted using the U.S. National Library of Medicine (PubMed), EMBASE, SCOPUS, and Cochrane databases with a final search performed in May 2020. The research identified papers published later than 2000 with at least 50 single clinician procedures performed in EXT-DCR and END-DCR. Articles that studied acute infections, revision cases, mixed cohort studies of acquired and congenital obstruction, and tumour were excluded. The influence of systemic antibiotic/steroids, local application of mitomycin C, nasal/ocular antibiotic, nasal/ocular steroids and nasal decongestants was analysed.
RESULTS: In total, 11,445 papers were selected, 2,741 of which were reviewed after screening, and 18 included after full text review (0.6% of the initial articles reviewed) which involved 3,590 procedures. Considering the low number of publications on EXT-DCR, statistical analysis of post-surgical therapy was not feasible. In END-DCR, the analyses were performed only for nasal steroids (p = 0.58), oral antibiotics (p = 0.45) and nasal decongestant (p = 0.27), which demonstrated no meaningful influence. Given the variable association between adjunctive medical therapies, pharmacologic molecular heterogeneity and modality/concentration of application, these results should be considered critically. Additionally, no differences were seen for application of silicone stenting, whereas, no statistical analysis was performed for mitomycin C.
CONCLUSIONS: Given the high success rate of EXT-DCR and END-DCR and the heterogeneity of literature data, the effective influence of post-surgical medical therapy is difficult to identify. Future large prospective randomized studies could help in detecting the optimal adjunctive therapy for these surgeries.
OBJECTIVE: To analyse the influence of post-surgical medical treatments on END-DCR and EXT-DCR outcomes.
METHODS: A structured search was conducted using the U.S. National Library of Medicine (PubMed), EMBASE, SCOPUS, and Cochrane databases with a final search performed in May 2020. The research identified papers published later than 2000 with at least 50 single clinician procedures performed in EXT-DCR and END-DCR. Articles that studied acute infections, revision cases, mixed cohort studies of acquired and congenital obstruction, and tumour were excluded. The influence of systemic antibiotic/steroids, local application of mitomycin C, nasal/ocular antibiotic, nasal/ocular steroids and nasal decongestants was analysed.
RESULTS: In total, 11,445 papers were selected, 2,741 of which were reviewed after screening, and 18 included after full text review (0.6% of the initial articles reviewed) which involved 3,590 procedures. Considering the low number of publications on EXT-DCR, statistical analysis of post-surgical therapy was not feasible. In END-DCR, the analyses were performed only for nasal steroids (p = 0.58), oral antibiotics (p = 0.45) and nasal decongestant (p = 0.27), which demonstrated no meaningful influence. Given the variable association between adjunctive medical therapies, pharmacologic molecular heterogeneity and modality/concentration of application, these results should be considered critically. Additionally, no differences were seen for application of silicone stenting, whereas, no statistical analysis was performed for mitomycin C.
CONCLUSIONS: Given the high success rate of EXT-DCR and END-DCR and the heterogeneity of literature data, the effective influence of post-surgical medical therapy is difficult to identify. Future large prospective randomized studies could help in detecting the optimal adjunctive therapy for these surgeries.
摘要：
背景：顿流是一种常见的眼科征象，最常见的是远端获得性泪道阻塞。最近的数据表明，外部泪囊鼻腔吻合术（EXT-DCR）和内窥镜鼻内泪囊鼻腔吻合术（END-DCR）可以被认为是首选的治疗方法。然而,不同的手术后药物治疗是可用的，目前用于改善手术结果，尽管没有进行直接比较。
目的：分析术后药物治疗对END-DCR和EXT-DCR结局的影响。
方法：使用美国国家医学图书馆（PubMed）进行了结构化搜索，EMBASE,Scopus,和Cochrane数据库，最终搜索于2020年5月进行。该研究确定了2000年以后发表的论文，其中至少有50个临床医生在EXT-DCR和END-DCR中进行了手术。研究急性感染的文章，修订案例，获得性和先天性梗阻的混合队列研究，肿瘤被排除。全身性抗生素/类固醇的影响，丝裂霉素C的局部应用，鼻/眼抗生素，分析了鼻/眼类固醇和鼻减充血剂。
结果：总计，选择了11,445篇论文，其中2,741人在筛查后进行了审查，和18个包括在全文审查后(最初审查的文章的0.6%)，涉及3,590个程序。考虑到EXT-DCR的出版物数量少，术后治疗的统计学分析不可行.在END-DCR中,仅对鼻腔类固醇进行分析（p=0.58），口服抗生素（p=0.45）和鼻减充血剂（p=0.27），这表明没有意义的影响。考虑到辅助药物治疗之间的可变关联，药理分子异质性和应用方式/浓度，这些结果应该被批判性地考虑。此外,硅胶支架的应用没有差异，然而,未对丝裂霉素C进行统计学分析。
结论：鉴于EXT-DCR和END-DCR的成功率较高以及文献数据的异质性，手术后药物治疗的有效影响很难确定。未来的大型前瞻性随机研究可能有助于检测这些手术的最佳辅助疗法。
目的：分析术后药物治疗对END-DCR和EXT-DCR结局的影响。
方法：使用美国国家医学图书馆（PubMed）进行了结构化搜索，EMBASE,Scopus,和Cochrane数据库，最终搜索于2020年5月进行。该研究确定了2000年以后发表的论文，其中至少有50个临床医生在EXT-DCR和END-DCR中进行了手术。研究急性感染的文章，修订案例，获得性和先天性梗阻的混合队列研究，肿瘤被排除。全身性抗生素/类固醇的影响，丝裂霉素C的局部应用，鼻/眼抗生素，分析了鼻/眼类固醇和鼻减充血剂。
结果：总计，选择了11,445篇论文，其中2,741人在筛查后进行了审查，和18个包括在全文审查后(最初审查的文章的0.6%)，涉及3,590个程序。考虑到EXT-DCR的出版物数量少，术后治疗的统计学分析不可行.在END-DCR中,仅对鼻腔类固醇进行分析（p=0.58），口服抗生素（p=0.45）和鼻减充血剂（p=0.27），这表明没有意义的影响。考虑到辅助药物治疗之间的可变关联，药理分子异质性和应用方式/浓度，这些结果应该被批判性地考虑。此外,硅胶支架的应用没有差异，然而,未对丝裂霉素C进行统计学分析。
结论：鉴于EXT-DCR和END-DCR的成功率较高以及文献数据的异质性，手术后药物治疗的有效影响很难确定。未来的大型前瞻性随机研究可能有助于检测这些手术的最佳辅助疗法。
