Sondagem no tratamento da obstrução lacrimonasal congênita: revisão sistemática de ensaios clínicos randomizados e metanálise
Arquivos
Data
2017-08-11
Autores
Farat, Joyce Godoy [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A sondagem lacrimal tem sido o tratamento de escolha para a obstrução lacrimonasal congênita (OLNC) que não apresenta resolução espontânea. No entanto, não há consenso sobre qual é a melhor época para a realização da sondagem e se ela é melhor do que outras terapias. Objetivo: Avaliar a efetividade da sondagem lacrimal no tratamento da OLNC. Método: Uma revisão sistemática da literatura foi realizada usando plataformas eletrônicas de busca para identificar estudos de OLNC comparando sondagem lacrimal com outros tratamentos ou nenhuma intervenção. A qualidade da evidência foi avaliada pelo sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Resultados: Quatro ensaios clínicos randomizados foram incluídos, envolvendo 423 participantes. A metanálise mostrou que não houve diferença estatística na resolução da OLNC entre o grupo submetido à sondagem lacrimal precoce e o submetido à observação/sondagem tardia (2 estudos; RR 1.00 [0.76, 1.33] p=0,99, I2=79%, baixa qualidade de evidência). Nas representações de metanálise, o desfecho taxa de resolução da sondagem tardia comparada à intubação bicanalicular com silicone não teve diferença estatística (1 estudo, RR 0.94 [IC 95% 0.84, 1.06] p=0,31, moderada qualidade de evidência), porém houve diferença no subgrupo das OLNCs complexas, favorecendo a intubação nesses casos (1 estudo; RR 0.56 [0.34, 0.92] p=0,02, moderada qualidade de evidência). Conclusões: A sondagem lacrimal precoce tem a mesma chance de sucesso terapêutico que a tardia na OLNC (baixa qualidade de evidência); a sondagem tardia tende a ter a mesma chance de sucesso terapêutico que a intubação bicanalicular com silicone na OLNC simples (moderada qualidade de evidência); a taxa de sucesso da sondagem tardia tende a ser inferior à da intubação bicanalicular com silicone em casos de OLNCs complexas (moderada qualidade de evidência).
Introduction: Lacrimal probing has been the treatment of choice for congenital nasolacrimal duct obstruction (CNLDO) that does not have spontaneous resolution. However, there is no consensus about the best time for probing and if it is better than other therapies. Objective: To evaluate the effectiveness of lacrimal probing in the treatment of CNLDO. Method: A systematic review of the literature was performed using electronic search platforms to identify CNLDO studies to compare early or late lacrimal probing with other treatments or no intervention. The quality of the evidence was evaluated by the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). Results: Four randomized clinical trials were included, involving 423 participants. The meta-analysis showed no statistically significant difference between the immediate probing and the observation/ late probing, in the outcome of the CNLDO resolution rate (2 studies, RR 1.00 [0.76, 1.33] p=0,99, I2 = 79%, low quality of evidence). In the meta-analysis representations, the outcome resolution rate of CNLDO comparing late probing and bicanalicular intubation with silicone showed no statistically significant difference (1 study, RR 0.94 [IC 95% 0.84, 1.06] p=0,31, moderate quality of evidence), however there was a difference favoring bicanalicular intubation with silicone in the subgroup complex CNLDOs (1 study; RR 0.56 [0.34, 0.92] p = 0.02, moderate quality of evidence). Conclusions: Early probing has the same chance of therapeutic success as the late probing in CNLDO (low quality of evidence); late probing tends to have the same chance of therapeutic success as bicanalicular silastic intubation in CNLDO (moderate quality of evidence); the success rate of late probing tends to be lower than the therapeutic success of bicanalicular intubation with silastic in cases of complex CNLDO (moderate quality of evidence).
Introduction: Lacrimal probing has been the treatment of choice for congenital nasolacrimal duct obstruction (CNLDO) that does not have spontaneous resolution. However, there is no consensus about the best time for probing and if it is better than other therapies. Objective: To evaluate the effectiveness of lacrimal probing in the treatment of CNLDO. Method: A systematic review of the literature was performed using electronic search platforms to identify CNLDO studies to compare early or late lacrimal probing with other treatments or no intervention. The quality of the evidence was evaluated by the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). Results: Four randomized clinical trials were included, involving 423 participants. The meta-analysis showed no statistically significant difference between the immediate probing and the observation/ late probing, in the outcome of the CNLDO resolution rate (2 studies, RR 1.00 [0.76, 1.33] p=0,99, I2 = 79%, low quality of evidence). In the meta-analysis representations, the outcome resolution rate of CNLDO comparing late probing and bicanalicular intubation with silicone showed no statistically significant difference (1 study, RR 0.94 [IC 95% 0.84, 1.06] p=0,31, moderate quality of evidence), however there was a difference favoring bicanalicular intubation with silicone in the subgroup complex CNLDOs (1 study; RR 0.56 [0.34, 0.92] p = 0.02, moderate quality of evidence). Conclusions: Early probing has the same chance of therapeutic success as the late probing in CNLDO (low quality of evidence); late probing tends to have the same chance of therapeutic success as bicanalicular silastic intubation in CNLDO (moderate quality of evidence); the success rate of late probing tends to be lower than the therapeutic success of bicanalicular intubation with silastic in cases of complex CNLDO (moderate quality of evidence).
Descrição
Palavras-chave
Ducto nasolacrimal/ anormalidades, Obstrução dos ductos lacrimais/ congênito, Obstrução dos ductos lacrimais/ terapia, Metanálise, Revisão, Lactente, Pré-escolar, Nasolacrimal duct/ abnormalities, Lacrimal duct obstruction/ congenital, Lacrimal duct obstruction/ therapy, Meta-analysis, Review, Infant, Child, preschool