JAN 24, 2011
Oculoplastics/Orbit
Several recent studies have investigated adjunctive mitomycin C (MMC) for dacryocystorhinostomy (DCR) to improve the success rate. The purpose of this study was to evaluate the efficacy of intraoperative MMC in endonasal endoscopic DCR for primary acquired nasolacrimal duct obstruction (PANDO).
Investigators randomized 50 adult patients with PANDO to standard endonasal endoscopic DCR with mucosal flaps plus MMC or placebo. The 12-month success rate for both groups was similar (84.6 percent for MMC and 79.2 percent for controls). However it did appear to improve ostium healing. At six and 12 months postop, the mean ostium size in the MMC group (10.8 mm2 and 3.0 mm2, respectively) was significantly larger than that of the control group (7.1 mm2 and 1.6 mm2, respectively). There were nine cases of failure in which the patients had persistent epiphora, four in the MMC group and five in the placebo group - all due to stenosis of the ostium. There were no MMC-related complications.
The authors conclude that despite the large postoperative ostium sizes in the MMC group, this study's results do not advocate the routine use of intraoperative MMC for endonasal endoscopic dacryocystorhinostomy, as the success rate might also be due, in part, to the study's small sample size or any number of other factors, including the surgeon's technique and ability.