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K Bakri, NS Jones, R Downes, A Sadiq; Intraoperative 5-Fluorouracil in Endonasal Laser Dacryocystorhinostomy . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3022.
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Purpose: Although endonasal laser dacryocystorhinostomy (ELDCR) offers many advantages over conventional techniques, the incidence of post-operative scarring leading to occlusion of the rhinostomy is more common than conventional surgery. The aim of this study was to investigate whether 5-fluorouracil (5-FU) applied to the rhinostomy site intraoperatively has an effect on the outcome of the procedure. Participants: 155 consecutive patients (201 procedures) were randomly allocated to 2 groups - a control group and a 5-FU group. The choice of treatment was masked from both patients and investigators. Methods: ELDCR was performed on all patients. A pledget soaked in either normal saline or 0.5mg/ml 5-FU was applied to the rhinostomy site for 5 minutes at the time of surgery. Patients were followed up for 12 months and their symptoms assessed at each visit. Results: ELDCR procedures performed with topical application of 5-fluorouracil to the rhinostomy site showed a success rate of 76% at 12 months. ELDCR procedures performed with topical application of 0.9% saline showed a success rate of 63% at 12 months. This was not statistically significant (p≷0.05, Chi-squared test). Conclusion: The topical application of 5FU failed to increase the patency rates in ELDCR. Given the overall success rate at 12 months (58% if non-attenders counted as failures, 76% if regarded as successes), the place of ELDCR can no longer be advocated as the procedure of choice except in anticoagulated patients as endoscopic DCR done with mucosal flaps or external DCR gives superior results.
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