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M. Manning, J. Tao, J.D. Siddens, R. Trespalacios; Extended Application (2 Hour) of Mitomycin C in Repeat Dacryocystorhinostomy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4428.
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Purpose:Dacryocystorhinostomy (DCR) is an effective procedure for the treatment of epiphora caused by nasolacrimal duct obstruction. While primary DCR has a success rate of about 90%, revision DCR for failed primary surgery has only about 75% success. The application of an antiproliferative agent, mitomycin C, for 30 minutes intraoperatively has shown to be effective at increasing the success rate of primary DCR by its inhibition of fibrous tissue growth and scarring at the osteotomy site. While beneficial, mitomycin C application is not without risks. The purpose of this study is to evaluate the results of an extended (2 hour) application of mitomycin C in repeat DCR. Methods: In this retrospective study, the authors reviewed 12 patients with symptoms of recurrent epiphora after DCR who subsequently underwent the following: In the OR, the patient was placed supine, and given IV sedation. Local anesthesia was given, using a 1:1 ratio of 1% lidocaine and 0.5% marcaine, both with epinephrine. The nasopharynx was packed with nu–gauze soaked in 4% cocaine solution. Topical anesthesia and a corneal protector were applied. Betadine was used to prep and the patient was covered with sterile drapes. The packing was removed and a 30 degree rigid endoscope was used to evaluate the previous surgery site. Scarring was found to completely cover the surgical ostium. Using a Javate cutting electrode with the Ellman Surgitron, the scarring was removed. Gentle probing confirmed the connection from the lacrimal system into the nasopharynx. Mitomycin C was reconstituted in 0.5% concentration, placed on a neurosurgical cottonoid, and then placed into the surgical ostium and secured with taping of its string to the upper lip. Crawford tubes were then introduced and secured in the nare with 6–0 nylon sutures. The patient was taken to recovery where the cottonoid was then removed in 2 hours. Results:Among the 12 eyes reviewed, all showed symptomatic improvement after 6 months and up to 2 years of follow up. All 12 eyes were classified as having normal tear meniscus levels. Thus, all patients evaluated were presumed to have sustained patency and therefore surgically successful treatment. There were no complications such as delayed wound healing, abnormal nasal bleeding, mucosal necrosis, or infection. Conclusions: In this series of patients, DCR with extended (2 hour) application of mitomycin C is effective in achieving nasolacrimal duct patency at 6 months and up to 2 years postoperatively in patients undergoing revision DCR. No significant complications resulted from its use. Further investigation is warranted to assess the most appropriate duration of application.
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