The Efficacy of Application of Mitomycin-C in Endoscopic Endonasal Dacryocystorhinostomy

Abstract

Study Design: Prospective study.

Aim of the Study: The aim of this study was to evaluate the efficacy of intraoperative Mitomycin-C application to the surgically created stoma during endoscopic endonasal dacryocystorhinostomy (DCR) and to compare the outcomes with those of endoscopic endonasal DCR performed without Mitomycin-C.

Time and Place: The study was conducted at Al-Sadder Medical City, Al-Najaf Governorate, during the period from March 2012 to April 2014.

Patients and Methods: A total of 67 eyes from 64 patients were included in the study, comprising 46 females and 18 males, with ages ranging from 5 to 56 years. Patients were randomly divided into two groups:
Group 1: Endoscopic endonasal DCR performed without Mitomycin-C.
Group 2: Endoscopic endonasal DCR with intraoperative application of Mitomycin-C (0.2 mg/mL) to the created stoma for 5 minutes.

Results: The mean age was 21.7 years for males and 35.29 years for females. Nasal synechiae at the ipsilateral surgical site were observed in 5 patients (15.6%) in Group 1 and 3 patients (9.4%) in Group 2. Granulation tissue formation around the stoma, representing surgical failure, occurred in 2 patients (6.25%) in Group 1 and 1 patient (3.1%) in Group 2.

Conclusion: Endoscopic endonasal DCR is a safe and effective procedure for the treatment of distal lacrimal apparatus obstruction. It can be considered for patients of all age groups, particularly those wishing to avoid a facial scar. However, definitive evidence regarding the relative efficacy of Mitomycin-C in endoscopic endonasal DCR remains inconclusive. While some studies report high success rates with Mitomycin-C use, others do not support its benefit. Although antimitotic agents represent a promising adjunct in endoscopic lacrimal surgery and appear safe and easy to use intraoperatively, the present study and other limited series demonstrate no significant advantage associated with their use.