Results Of Intraoperative Mitomycin C Application In Dacryocystorhinostomy PDF

Downloaded from http://bjo.bmj.com/ on March 25, 2015 - Published by group.bmj.com Br J Ophthalmol 2000;84:903–906 903 Results of intraoperative mitomycin C application...

Downloaded from http://bjo.bmj.com/ on March 25, 2015 - Published by group.bmj.com Br J Ophthalmol 2000;84:903–906 903 Results of intraoperative mitomycin C application in dacryocystorhinostomy Shu L Liao, Shine C S Kao, Jason H S Tseng, Muh S Chen, Ping K Hou Abstract studies, it appears that the success rate for this Aims—To evaluate the long term results of procedure is about 90%.1–3 The two most intraoperative mitomycin C application in frequent causes of DCR failure are obstruction dacryocystorhinostomy (DCR) surgery of the common canaliculus and closure of the compared with results of the conventional osteotomy site.4–6 Thus, if we can inhibit procedure. fibrous tissue growth and scarring by applying Methods—In this prospective randomised antiproliferative agents over the anastomosed controlled study, a total of 88 eyes diag- flaps and osteostomy site, the failure rate may nosed with acquired nasolacrimal duct be decreased. obstruction were randomly divided into a Mitomycin C, an antiproliferative agent, has conventional DCR group and a mitomycin been widely used in pterygium excision and C group in which mitomycin C was used trabeculectomy with favourable results.7 8 Our during DCR surgery. The surgical proce- previous study also demonstrated that DCR dures in both groups were exactly the with intraoperative mitomycin C application same, except that in the patients in the can maintain larger osteotomy size than that of mitomycin C group, a piece of neurosur- the conventional procedure.9 In this paper, we gical cottonoid soaked with 0.2 mg/ml evaluate the long term success rate of DCR mitomycin C was applied to the osteotomy surgery with intraoperative mitomycin C soak- site for 30 minutes. The results of the DCR ing. surgeries were evaluated by objective findings such as irrigation and the height of tear meniscus and subjective symptoms Subjects and methods by asking patients the condition of tearing During 1995 to 1998, 88 patients with a diag- improvement. nosis of primary acquired nasolacrimal duct Results—Among the 44 eyes in the mito- obstruction were randomly assigned into mito- mycin C group, 95.5% of patients re- mycin C and conventional DCR groups. All mained totally symptom free after 10 the procedures were performed by two sur- months of follow up; while in the conven- geons (SCSK and SLL). The mean age of the tional group, 70.5% of patients were conventional group was 57.4 (SD 10.2) years, reported to be symptom free and 18% of and that of the mitomycin C group was 57.9 patients to have an improvement in their (7.4) years. All the patients had been followed symptoms. There was a significant diVer- up for more than 10 months for the evaluation ence between these two groups. As far as of objective findings as well as subjective symp- objective findings were concerned, there toms. were 41 eyes in the mitomycin C group The standard surgical techniques of an classified as having a normal and one eye external DCR were used in all patients of both with moderate tear meniscus level, com- groups. Local infiltrative anaesthesia, consist- pared with 32 eyes and seven eyes, respec- ing of 2% lignocaine (lidocaine) and 1:100 000 tively, in the conventional group. There adrenaline (epinephrine), was administered in was also a significant diVerence between the region of the medial canthus and lower lid. these two groups. The non-patency rate in The nasal mucosa was anaesthetised and the mitomycin C group is 4.5% compared vasconstricted with pledgets saturated with a with 11.4% in the conventional group. mixture of 5% cocaine and 1:100 000 adrena- There were no complications such as line. A skin incision was performed and blunt abnormal nasal bleeding, mucosal necro- dissection to the periosteum overlying the Department of sis, or infection except one patient with anterior lacrimal crest was undertaken. The Ophthalmology periosteum was then incised and elevated oV National Taiwan delayed wound healing. Conclusions—Intraoperative mitomycin the lacrimal sac fossa. The osteotomy was cre- University Hospital, 7, Chung-Shan S Road C application is eVective in increasing the ated over the lacrimal fossa with an electric Taipei, Taiwan success rate of DCR surgery in standard drill. The lacrimal sac was opened in a longitu- S L Liao nasolacrimal duct obstruction, and no dinal fashion to form anterior and posterior S C S Kao significant complications resulted from its flaps. The nasal mucosa was cut in a similar J H S Tseng fashion to the lacrimal sac. Then, the posterior M S Chen use. (Br J Ophthalmol 2000;84:903–906) nasal and lacrimal sac flaps were joined with P K Hou 5-0 Vicryl suture. A silicone tube was used to Correspondence to: intubate the lacrimal system and followed by Dr Shu Lang Liao Most ophthalmic surgeons accept dacryo- being tied together with a 4-0 silk suture. In the [email protected] cystorhinostomy (DCR) as a highly successful mitomycin C group, once the silicone tube was Accepted for publication procedure in managing epiphora due to in place, a piece of neurosurgical cottonoid 13 April 2000 nasolacrimal duct obstruction. From previous attached with a long thread, saturated with 0.2 www.bjophthalmol.com  Downloaded from http://bjo.bmj.com/ on March 25, 2015 - Published by group.bmj.com 904 Liao, Kao, Tseng, et al mg/ml mitomycin C was placed over the anas- tear meniscus. One eye sample was classified as tomosed posterior flaps and osteotomy site having moderate and 41 eye samples as having with the long thread passing out through the normal tear meniscus levels. In the conven- nostril, and was then removed transnasally tional group, five eye samples were classified as after an application time of 30 minutes. The having a high tear meniscus, seven eye samples anterior nasal and lacrimal sac flaps were as a moderate tear meniscus, and 32 eye closed with additional 5-0 Vicryl sutures, as samples as a normal tear meniscus. The objec- were the periosteum and orbicularis muscle in tive findings of tear meniscus height showed a separate layers. The skin incision was sutured significant diVerence between the two groups with a running 6-0 nylon suture. The mitomy- (p 0.2 mm), moderate tear mitomycin C soaked sponge on the skin wound meniscus (0.1 mm