Comparing the Success Rate of Dacryocystorhinostomy With and Without Silicone Intubation: A Trial Sequential Analysis of Randomized Control Trials

A previous meta-analysis reported no benefit for silicone intubation during dacryocystorhinostomy. However, the power of this meta-analysis was 0.274. Therefore, the benefit of silicone intubation remains controversial. We undertook a cumulative meta-analysis to evaluate the success rate of dacryocystorhinostomy (DCR) with and without the use of a stent. Pubmed, EMBASE and the Cochrane Library were searched. Statistical power and trial sequential analyses were performed according to the result of the meta-analysis. Twelve randomized controlled trials involving 969 cases met the inclusion criteria. The success rates of DCR with and without intubation were significantly different (p = 0.006). The success rates of external DCR (EX-DCR) with and without intubation were also significantly different based on subgroup analysis (p = 0.002). The cumulative z-curves crossed the O’Brian-Fleming boundaries. There were no significant differences in the success rate in the endonasal endoscopic DCR (EN-DCR) subgroup or the occurrence of postoperative complications between the two groups based on the meta-analysis, and the z-curve did not intersect any trial sequential analysis boundaries. DCR with intubation achieved better results than DCR without intubation, especially in the EX-DCR subgroup. Differences in the success rate in the EN-DCR subgroup and postoperative complications between the two groups were underpowered to reach a conclusion.