Endoscopic dacryocystorhinostomy in the pediatric population: a systematic review and meta-analysis

To systematically review the extant literature on pediatric endoscopic dacryocystorhinostomy (endoDCR) and to perform a meta-analysis of the pooled success rate and complication profile.

A comprehensive literature search was conducted using PubMed, Cochrane Library, and Web of Science databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they reported the pediatric endoDCR success rate with a minimum follow-up of 3 months and at least 10 patients. Data on success rates, complications, age, follow-up time, and silicone stent removal time were extracted. Statistical analyses were performed using comprehensive meta-analysis software.

Twenty-nine studies comprising 1502 pediatric eyes were included. The pooled success rate was 87% (95% CI: 0.83-0.90). The I² statistic was 58.47%, indicating moderate to substantial heterogeneity. Egger's test indicated significant publication bias (p < 0.00001). Complication rates varied considerably: while some studies reported minor complications in up to 60% of cases, others documented serious, but rare, events such as cerebrospinal fluid rhinorrhea (0.28%). The most common complications included bleeding/epistaxis, tube prolapse, adhesions/synechiae, and granulation tissue.

EndoDCR is an effective and generally safe surgical option for pediatric nasolacrimal duct obstruction, with a high pooled success rate and acceptable variability in outcomes. However, variation in complication reporting and methodological heterogeneity across studies highlights the need for standardization in future research.