Seventy-three studies were included in the review (n=4,800 participants, 4,921 procedures). One study was graded level 2b, eight were level 3b and 64 (87%) were level 4 (which indicated that they were probably cohort, case-control and case-series studies).
Success rates ranged from 47% to 100% for LA-DCR (15 studies), from 65% to 100% for EX-DCR (13 studies) and from 71% to 94% for EN-DCR (22 studies). Success rates for revision DCR was 100% for EX-DCR (one study), 69% to 100% for EN-DCR (five studies) and 43% for LA-DCR (one study).
At longer term follow-up, success rates after EX-DCR and EN-DCR were over 90% at 70 and 49 months and the success rate for LA-DCR was 38% at five years (one study each).
In studies of intra-operative metabolites, only three out of 11 studies reported any benefit from use of mitomycin-C and there was no evidence of benefit from 5-fluorouracil (two studies). There were five controlled studies of endocanalicular stenting, none of which found any evidence of benefit from stenting.
The overall intra-operative complication rate was 1% and the postoperative complication rate was 6.4%. The most commonly reported complications were wound haemorrhage and periorbital haematoma.