Results of intraoperative mitomycin C application in dacryocystorhinostomy

Abstract

Aims-To evaluate the long term results of intraoperative mitomycin C application in dacryocystorhinostomy (DCR) surgery compared with results of the conventional procedure. Methods-In this prospective randomised controlled study, a total of 88 eyes diagnosed with acquired nasolacrimal duct obstruction were randomly divided into a conventional DCR group and a mitomycin C group in which mitomycin C was used during DCR surgery. The surgical procedures in both groups were exactly the same, except that in the patients in the mitomycin C group, a piece of neurosurgical cottonoid soaked with 0.2 mg/ml mitomycin C was applied to the osteotomy site for 30 minutes. The results of the DCR surgeries were evaluated by objective findings such as irrigation and the height of tear meniscus and subjective symptoms by asking patients the condition of tearing improvement. Results-Among the 44 eyes in the mitomycin C group, 95.5% of patients remained totally symptom free after 10 months of follow up; while in the conventional group, 70.5% of patients were reported to be symptom free and 18% of patients to have an improvement in their symptoms. There was a significant diVerence between these two groups. As far as objective findings were concerned, there were 41 eyes in the mitomycin C group classified as having a normal and one eye with moderate tear meniscus level, compared with 32 eyes and seven eyes, respectively, in the conventional group. There was also a significant diVerence between these two groups. The non-patency rate in the mitomycin C group is 4.5% compared with 11.4% in the conventional group. There were no complications such as abnormal nasal bleeding, mucosal necrosis, or infection except one patient with delayed wound healing. Conclusions-Intraoperative mitomycin C application is eVective in increasing the success rate of DCR surgery in standard nasolacrimal duct obstruction, and no significant complications resulted from its use. (Br J Ophthalmol 2000;84:903-906) Most ophthalmic surgeons accept dacryocystorhinostomy (DCR) as a highly successful procedure in managing epiphora due to nasolacrimal duct obstruction. From previous studies, it appears that the success rate for this procedure is about 90%.1-3 The two most frequent causes of DCR failure are obstruction of the common canaliculus and closure of the osteotomy site.4-6 Thus, if we can inhibit fibrous tissue growth and scarring by applying antiproliferative agents over the anastomosed flaps and osteostomy site, the failure rate may be decreased.Mitomycin C, an antiproliferative agent, has been widely used in pterygium excision and trabeculectomy with favourable results. 7 8 Our previous study also demonstrated that DCR with intraoperative mitomycin C application can maintain larger osteotomy size than that of the conventional procedure.9 In this paper, we evaluate the long term success rate of DCR surgery with intraoperative mitomycin C soaking. Subjects and methodsDuring 1995 to 1998, 88 patients with a diagnosis of primary acquired nasolacrimal duct...

A comparative study on intraoperative mitomycin-c augmented external dacryocystorhinostomy with conventional dacryocystorhinostomy

“…Success rate of external DCR has been reported between 80-99% and average failure rate as reported in literature is 9.4%. [3][4][5][6][7][8]15,17,24 Failure is generally defined as having symptoms of excessive tearing with the inability to irrigate. Mc Pherson and Egelston noted that three out of seven patients in their study who underwent a second operation were found to have dense scar tissue present at the osteotomy site.…”

“…15,16 Intraoperative application of Mitomycin C in DCR should prevent shrinkage of the final surface area of osteotomy, thereby inhibiting scarring around the common canaliculus opening and also prevent adhesion between osteotomy site and nasal septum. 15,17,18 A comparative study of conventional DCR and DCR with intra-operative MMC will clearly establish the efficacy of mitomycin c in improving the success rate in DCR. Hence, this prospective randomized study was undertaken to evaluate the role of mitomycin C in maintaining post-operative patency of nasolacrimal passage of DCR.…”

A comparative study in the use of topical mitomycin-C versus nasolacrimal stent in endoscopic dacryocystorhinostomy for chronic dacryocystitis

“…24,25 Liao et al used 0.2 mg/ml of MMC externally on the posterior flap and on the osteotomy site and removed after 30 min. 21 They reported 95.5% success rate.…”

“…15, [20][21][22] Mitomycin-C, an alkaline agent is isolated from fermentation filtrate of 'Streptomyces caespitosus'. After intracellular enzyme reduction of the quinine and loss of methoxy, mitomycin-C becomes bifunctional or trifunctional alkylating agent.…”

Therapeutic methods of scar prevention at the site of endonasal dacryocystorhinostomy

“…Применяли данную методику и другие авторы, ис-пользуя концентрации митомицина-С от 0,2 мг/мл до 0,5 мг/мл [13,14], также вариабельным было время аппли-кации от 2 до 15 мин [15,16]. Период наблюдения за паци-ентами после операции также был различным и составлял от 6 до 12 мес [17,18].…”