Waseem Raja, Mohd. Ayaz Bhat, Mahrukh
BACKGROUND Dacryocystorhinostomy (DCR) is done for management of epiphora due to nasolacrimal duct obstruction. Common causes of DCR failure are fibrous tissue growth, scarring and granulation tissue formation which obstructs the new drainage channel formed after conventional DCR surgery. Mitomycin-C is an anti-proliferative agent and may enhance the result of DCR by inhibiting fibrous tissue proliferation. MATERIALS AND METHODS A prospective randomized comparative study of one-year duration was done in the Department of Ophthalmology, District Hospital, Pulwama, Kashmir (J and K) India. A total of 100 patients of acquired nasolacrimal duct obstruction were enrolled and divided randomly into two groups, 50 of patients in each group. One group had undergone conventional external DCR operation and other group was treated with DCR surgery with intraoperative mitomycin-C application, in this, 0.2mg/ml MMC was applied at flaps and osteotomy site. Patients were reviewed after 1 week, 1 month, 3 months and 6 months postoperatively. The results of DCR surgeries were evaluated by observation of different parameters such as height of tear of meniscus and patency of the nasolacrimal passage. RESULTS In our study, we have observed that majority of cases were in 21-30 years age group with female preponderance (male vs female; 35% vs 75%). Major difficulties encountered during surgery and postoperatively were almost identical in both the groups. There was no case of abnormal mucosal bleeding, mucosal necrosis, delayed wound healing in patients who underwent DCR with mitomycin C use. Post-operative care and follow up were done identically in both the groups. It was seen that a total success rate of 86.25% was achieved in conventional group where as 97.50% success was achieved in MMC group at the end of 6 months, The difference in success rate was statistically significant (p=0.017). In case of scar prone conditions like lacrimal fistula mitomycin-C use has shown to be efficacious in maintaining patency of the system after surgery. CONCLUSION Intraoperative mitomycin-C application is effective in increasing the success rate of DCR surgery in standard nasolacrimal duct obstruction, and no significant complications resulted from its use. Use of intraoperative mitomycin-C can be considered safe and simple but very effective modification of conventional external DCR.
