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Clinical outcomes of dacryocystorhinostomy with or without intraoperative use of mitomycin C: a systematic review and meta-analysis.

PURPOSE
To examine the possible benefit of intraoperative use of mitomycin C (MMC) application in dacryocystorhinostomy (DCR) and to assess its potential risk.


METHODS
Systematic review and meta-analysis of randomized-controlled trials (RCTs). A comprehensive literature search was performed according to a protocol set in advance. The participants included 811 patients of which 820 eyes were sampled for 14 RCTs. Only pertinent RCTs were identified and included in this meta-analysis. The primary efficacy measure was "patency of irrigation" at follow-up end point. The subjective outcome of "symptom relief" was also extracted as a secondary efficacy measure. For each study, relative risk was extracted. Heterogeneity, publication bias, subgroup, and meta-regression analyses were performed.


RESULTS
RevMan version 5.0 software was used for statistical analysis. In the primary efficacy measure, the use of MMC can significantly increase the rate of "patency of irrigation" [risk ratio (RR), 1.10; 95% confidence interval (CI), 1.04-1.17; P=0.0006]; the outcome of "symptom relief" was also affected by the use of MMC (RR, 1.15; 95% CI, 1.05-1.26; P=0.003). Sensitivity analysis suggested that the result was comparatively reliable.


CONCLUSION
Intraoperative use of MMC can bring about a positive effect to the outcomes of "patency of irrigation" and "symptom relief," which increases the success rate of DCR surgery.