Antimetabolites as an adjunct to dacryocystorhinostomy for nasolacrimal duct obstruction

Phelps, Paul O.; Abariga, Samuel A; Cowling, Benjamin J.; Selva, Dinesh; Marcet, Marcus M.

doi:10.1002/14651858.cd012309.pub2

Cited by 18 publications

(12 citation statements)

References 57 publications

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“…If the latter seems to improve the final result even if no significant influence has been noted, [38][39][40] mitomycin C, an anti-fibroblasts proliferation agent that can be applied in different concentration, timing and modalities, presents an unclear role on the final outcome making its usage not standardized. [34][35][36][37] Both results of these adjunctive therapies have been confirmed by our analyses that, when feasible, did not find a significant influence regarding its use.…”

Section: Discussionsupporting

confidence: 78%

“…3 If considering the potential influencing factors on the outcomes of these techniques, several studies have highlighted the role of MMC and silicone stenting, which in some cases seems to improve the success rate, with no unanimous consensus achieved. [34][35][36][37][38][39][40] Additionally, recent reviews have demonstrated that, neither the possible combinations of post-operative therapies (e.g. oral antibiotics, nasal/ocular steroids or nasal/ocular antibiotics), nor the type of surgery and mucosal flaps, have a significant influence on the final surgical result.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Role of anaesthesia in endoscopic and external dacryocystorhinostomy: A meta-analysis of 3282 cases

Vinciguerra

Nonis

Resti

et al. 2021

European Journal of Ophthalmology

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Distal acquired lacrimal obstruction is a common adulthood pathology whose primary treatment is represented by EXT-DCR and END-DCR. When considering their influencing factors, the role of the type of anaesthesia applied during these surgeries has a major role. The aim of this study is to systematically analyse the influence of general and local/regional anaesthesia on the final success rates of EXT-DCR and END-DCR. Primary EXT-DCR and END-DCR articles published later than 2000 with at least 50 single clinician procedures were selected. Exclusion criteria included acute dacryocystitis, tumours, studies focussing on revision surgeries, surgeries with adjunctive procedures, not clearly demarcated surgeons, mixed cohort study of acquired and congenital disorders. This systematic review was conducted in accordance with MOOSE guidelines; where feasible, a meta-analysis of the collected results was conducted. As a result, 11,445 articles were selected of which 2741 were examined after screening, and 16 included after full text review (0.6% of the initial papers). Among all papers included, the number of EXT-DCR was not enough to provide a solid analysis of the effect of anaesthesia; conversely, a significant difference of success rate was noted between local anaesthesia + sedation (85.1%, IC 77.8%–90.4%), and general anaesthesia (90.8%, IC 88.8%–92.4%) in END-DCR ( p = 0.048). In conclusion, END-DCR performed with general anaesthesia should be considered as the solution of choice; however, local anaesthesia, eventually associated with a sedation, can be used as an alternative in selected cases. No meaningful conclusions could be drawn for EXT-DCR, due to the lack of data.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Role of anaesthesia in endoscopic and external dacryocystorhinostomy: A meta-analysis of 3282 cases

Vinciguerra

Nonis

Resti

et al. 2021

European Journal of Ophthalmology

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“…It is generally assumed that MMC improves surgical outcomes in both EXT-DCR and END-DCR, although given the high heterogeneity of studies, timing and concentration used, its role should be considered critically. [72][73][74][75][76] Generally, MMC is applied during the intervention, and as recently found, the concentration area of topical application declines rapidly in one day and some fibroblasts show regrowth within 48-72 hours: only one study mentioned that local continuous application of MMC through eye drops can be more effective to avoid fibrosis formation, compared to standard application. 33 Due the lack of data, these conclusions should be carefully evaluated and compared with stronger results.…”

Section: Discussionmentioning

confidence: 99%

Impact of Post-Surgical Therapies on Endoscopic and External Dacryocystorhinostomy: Systematic Review and Meta-Analysis

Vinciguerra

Nonis

Resti

et al. 2020

Am J Rhinol�Allergy

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Background Epiphora is a common ophthalmologic sign that is most commonly caused by distal acquired lacrimal obstruction. Recent data have demonstrated that external dacryocystorhinostomy (EXT-DCR) and endoscopic endonasal dacryocystorhinostomy (END-DCR) can be considered the treatments of choice. However, different post-surgical medical therapies are available and are currently used to improve surgical outcomes, although no direct comparison has been performed. Objective To analyse the influence of post-surgical medical treatments on END-DCR and EXT-DCR outcomes. Methods A structured search was conducted using the U.S. National Library of Medicine (PubMed), EMBASE, SCOPUS, and Cochrane databases with a final search performed in May 2020. The research identified papers published later than 2000 with at least 50 single clinician procedures performed in EXT-DCR and END-DCR. Articles that studied acute infections, revision cases, mixed cohort studies of acquired and congenital obstruction, and tumour were excluded. The influence of systemic antibiotic/steroids, local application of mitomycin C, nasal/ocular antibiotic, nasal/ocular steroids and nasal decongestants was analysed. Results In total, 11,445 papers were selected, 2,741 of which were reviewed after screening, and 18 included after full text review (0.6% of the initial articles reviewed) which involved 3,590 procedures. Considering the low number of publications on EXT-DCR, statistical analysis of post-surgical therapy was not feasible. In END-DCR, the analyses were performed only for nasal steroids (p = 0.58), oral antibiotics (p = 0.45) and nasal decongestant (p = 0.27), which demonstrated no meaningful influence. Given the variable association between adjunctive medical therapies, pharmacologic molecular heterogeneity and modality/concentration of application, these results should be considered critically. Additionally, no differences were seen for application of silicone stenting, whereas, no statistical analysis was performed for mitomycin C. Conclusions Given the high success rate of EXT-DCR and END-DCR and the heterogeneity of literature data, the effective influence of post-surgical medical therapy is difficult to identify. Future large prospective randomized studies could help in detecting the optimal adjunctive therapy for these surgeries.

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“…In a recent review comparing antimetabolites (MMC and 5-FU) with control treatments in patients undergoing DCR, a slight superiority of these agents in terms of anatomical and functional outcomes was reported. In that review, it was stated that studies usually utilized MMC as the antimetabolite agent, and no studies examined the usefulness of 5-FU independently, although its use in patients with nasolacrimal duct obstruction was recommended [ 40 ]. Some of the studies included in that review also used silicone intubation and antimetabolites concurrently, which precludes an assessment of the effect of 5-FU or MMC alone on the outcomes.…”

Section: Discussionmentioning

confidence: 99%

Success Rate Comparis on of External Dacryocystorhinostomy with 5-FU Application or Silicone Tube Intubation

Dirim

Türker

Doğan

et al. 2022

Journal of Ophthalmology

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Aims. To compare anatomical and functional success rates in patients with primary acquired nasolacrimal duct obstruction undergoing external dacryocystorhinostomy (EX-DCR) either with adjunctive 5-fluorouracil (5-FU) or silicone tube intubation. Methods. In this retrospective comparative study, 37 eyes in 32 patients who underwent EX-DCR with adjunctive 5-FU (5-FU group) and 43 eyes in 40 patients who underwent EX-DCR with silicone intubation (controls) between 2018 and 2019 were included. Results. The mean age of patients in 5-FU and control groups was 59.8 ± 9.4 and 57.0 ± 15.3 years, respectively. The mean follow-up was 18.70 ± 3.47 months in the 5-FU group and 21.38 ± 7.76 months in the control group. Anatomical success was determined based on patency rates at the time of irrigation and recurrence, while subjective symptoms (improvement in tearing) were used to evaluate the functional success. Lacrimal patency rates in 5-FU and control groups were 83.3% and 86.0%, respectively, while recurrence was observed in 16.2% of 5-FU and 14.0% of control subjects. The two groups were comparable in terms of patency and recurrence rates ( p = 0.777 ) as well as rates of epiphora ( p = 0.212 ). Conclusion. Both EX-DCR procedures were effective in the management of nasolacrimal duct obstruction. Our results suggest that EX-DCR augmented with 5-FU may represent a more feasible and cost-effective therapeutic option as compared to silicone tube placement in these patients.

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Antimetabolites as an adjunct to dacryocystorhinostomy for nasolacrimal duct obstruction

Cited by 18 publications

References 57 publications

Role of anaesthesia in endoscopic and external dacryocystorhinostomy: A meta-analysis of 3282 cases

Role of anaesthesia in endoscopic and external dacryocystorhinostomy: A meta-analysis of 3282 cases

Impact of Post-Surgical Therapies on Endoscopic and External Dacryocystorhinostomy: Systematic Review and Meta-Analysis

Success Rate Comparis on of External Dacryocystorhinostomy with 5-FU Application or Silicone Tube Intubation

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