Comparative study of endonasal dacryocystorhinostomy with and without adjunctive topical use of Mitomycin C
Keywords:Chronic dacryocystitis, Endonasal dacryocystorhinostomy, Mitomycin C
Background: Endoscopic dacryocystorhinostomy has now established itself in the treatment of lacrimal obstruction. Failures in endoscopic dacryocystorhinostomy are mainly due to reclosure of the stoma in the lateral nasal wall. Mitomycin-C is an alkylating agent used in the chemotherapy of various cancers. Mitomycin-C when topically applied to mucosal tissues has been reported to inhibit excessive scar tissue and granulation tissue formation, resulting in greater success rates.
Methods: To evaluate the efficacy of Mitomycin-C in preventing reclosure of the dacryocystorhinostomy stoma, we performed a prospective, randomized case control study between November 2013 and October 2015. The study was conducted at tertiary care centre. The study sample consisted of 50 patients, who were randomly assigned to two groups, Group A which received the application of Mitomycin-C topically to the dacryocystorhinostomy stomal site and Group B which did not receive this intervention. The patients were regularly followed up for 6 months.
Results: 24 patients (96%) out of 25 in the Group A, had a successful surgical outcome. In Group B 23 patients (92%) out of 25 were symptom free after surgery. These results indicated no statistically significant difference between the two groups (p>0.05). Hence the results of this study did not show any significant benefit for the use of Mitomycin-C as an adjunct during primary endoscopic dacryocystorhinostomy.
Conclusions: An atraumatic and meticulous surgical technique along with a good follow up care post-operatively establishes endoscopic dacryocystorhinostomy as an effective treatment modality for chronic dacryocystitis.
Fergie N, Jones NS. Dacryocysto-rhinostomy. In: Michael Gleeson, George G Browning, Martin J Burton, Ray Clarke et al, editors. Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery. 7th edition. Volume 2. Great Britain: Hodder Arnold; 2008: 1689-1698.
Dalgleish R. Idiopathic acquired lacrimal drainage obstruction. British J Ophthalmol. 1967;51:463-8.
Ragab SM, Elsherif HS, Shehata EM, Younes A, Gamea AM. Mitomycin CEnhanced Revision Endoscopic Dacryocystorhinostomy: A Prospective Randomized Controlled Trial. Otolaryngol Head Neck Surg. 2012;147(5):937-42.
West JM. A window resection of the nasal duct in cases of stenosis. Trans Am Ophthalmol Soc. 1914;12:654.
Halle M. Zur intranasalen Operation am Tranensack. Laryngol Rhinol 1914;100:41-4.
Mc Donogh M, Meiring JH. Endoscopic transnasal dacryocystorhinostomy. J Laryngol Otol. 1989;103:585–57.
Wormald PJ. Powered endoscopic dacryocysto-rhinostomy. Laryngoscope. 2002;112:69-72.
Eloy P, Bertrand B, Martinez M, Hoebeke M, Watelet JB, Jamart J. Endonasal dacryocysto-rhinostomy: indications, technique and results. Rhinology. 1995;33:229-33.
Hurwitz JJ, Rutherford S, Computerized survey of lacrimal surgery patients. Ophthalmol. 1986;93:14-9.
Hartikainen J, Antila J, Varpula M, Puukka P, Seppä H, Grénman R. Prospective randomized comparison of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy. Laryngoscope. 1998;108:1861-6.
Mukhtar SA, Jamil AZ, Ali Z. Efficacy of External Dacryocystorhinostomy (DCR) with and without Mitomycin-C in Chronic Dacryocystitis. J Coll Physicians Surg Pak. 2014;24(10):732-5.
Selig YK, Biesman BS, Rebeiz EE. Topical application of mitomycin C in endoscopic dacryocystorhinostomy. Am J Rhinol. 2000;14(3):205-7.
Apuhan T, Eroglu F, Sipahier A, Yildirim YS. Effect of mitomycin C on endoscopic dacryocysto-rhinostomy. J Craniofac Surg. 2011;22(6):2057-9.
Ghosh S, Roychoudhury A, Roychaudhuri BK. Use of Mitomycin-C in ENDODCR. Indian J Otolaryngol Head Neck Surg. 2006;58(4):368-9.
Zilelioglu G, Ugurbas SH, Anadolu Y, Akiner M, Akturk T. Adjunctive use of mitomycin C on endoscopic lacrimal surgery. Br J Ophthalmol. 1998;82:63-6.
Sprekelsen MM, Barberan MT. Endoscopic dacryocystorhinostomy: surgical technique and results. Laryngoscope. 1996;106:187-9.
Metson R, Woog JJ, Puliafito CA. Endoscopic laser dacryocystorhinostomy. Laryngoscope. 1994;104:269-74.
Cokkeser Y, Evereklioglu C, Er H. Comparative external versus endoscopic dacryocystorhinostomy: Results in 115 patients (130 eyes). Otolaryngol Head Neck Surg. 2000;123:488-91.
Cheng SM, Feng YF, Xu L, Li Y, Huang Jh. Efficacy of Mitomycin C in Endoscopic Dacryocystorhinostomy: A Systematic Review and Meta-Analysis. PloS One 2013;8(5):e62737.
Harugop AS, Rekha BK, Mudhol RS, Zingade ND, Hugar SM, Das AT, Maheswaran M. A randomized placebo controlled trial of Mitomycin-C in surgical outcome of primary endoscopic dacryocysto-rhinostomy. Al Ameen J Med Sci. 2013;6(3):231-6.
Metson R. Endoscopic Dacryocystorhinostomy. In: Wackym PA, Rice DH, Schaefer SD, Eds. Minimally invasive surgery of the head, neck and cranial base. Philadelphia: Lippincott Williams and Wilkins; 2002: 311-318.
Singh G, Wilson MR, Foster CS. Mitomycin drops a treatment for pterygium. Ophthalmol.1988;95:813–21.
Camara JG, Bengzon AU, Henson RD. The safety and efficacy of mitomycin C in endonasal endoscopic laser assisted dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2000;16:114-8.
Prasannaraj T, Praveen Kumar BY, Narasimhan I, Shivaprakash KV. Significance of adjunctive mitomycin C in endoscopic dacryocystorhinostomy. American J Otolaryngol. 2012;33:47-50.
Gupta N. Improving Results in Endoscopic DCR. Indian J Otolaryngol Head Neck Surg. 2011;63(1):40-4.
Boush GA, Lemke BN, Dortzbach RK. Results of endonasal laser - assisted dacryocystorhinostomy. Ophthalmol. 1994;101:955-9.
Kong YT, Kim TI, Kong BW. A report of 131 cases of endoscopic laser lacrimal surgery. Ophthalmol. 1994;101:1793-800.
Woog JJ, Metson R, Puliafito CA. Holmium: YAG endonasal laser dacryocystorhinostomy. Am J Ophthalmol. 1993;116:1-10.