A Comparative Study on Intraoperative Local Mitomycine_ c Application in Primary Endoscopic Dacrocystorhinostomy (dcr) with Conventional Primary Endoscpic (dcr).

Abstract

Epiphora is an overflow of tears onto the face due to imperfect drainage of the tear conducting passages or excess lacrimal production. Dacrocystorhinostomy ( DCR) is recognized as the most suitable treatment for patients with obstruction of the lacrimal system at the level of lacrimal sac or in nasolacrimal duct with aim of creation a bypass between lacrimal sac and the nasal cavity ( 1 ) The two most frequent causes of DCR failure are obstruction of the common canaliculus and closure of the osteotomy site. Thus if we can inhibit fibrous tissue growth and scarring by applying antiproliferative agents over the anastamosed flaps and osteostomy site , the failure rate may be decreased. (2)Mitomycin C is an antibiotic, antineoplastic agent inhibiting DNA, RNA and Protein synthesis. ( 3 ) Objectives: To evaluate the use of local intraoperative Mitomycin C in endoscopic DCR and comparing this with endoscopic DCR without Mitomycin C. Methods: In our study, a total of 77 eyes diagnosed with aquired epiphora were divided into a (Mitomycin C group) that we use local application of Mitomycin C intraoperativly in endoscopic DCR, and a (Non Mitomycin C group) in which no Mitomycin C is used. All done at Al-amal- day-case private clinic and Baqubah teaching hospital since 7th of May 2019 till 1st of March 2022. Surgical procedures steps is the same in both groups, except in that (Mitomycin C) group was subjected to an application of local mitomycin C 0.2mg\ml for 5 minutes and this was done with the aid of Merocele that soaked in this substance. Merocele soaked with Mitomycin C 0.2mg\ml was applied to the osteotomy site and the margines of the flaps of the opening of the lacrimal sac for 5 minutes. The results of surgeries in both groups were evaluated by both subjectivly by asking patients about the result of surgery and if they still complaining of excessive tearing or not , and also were evaluated objectivly (by flexible fibro-optic nasoendoscope) to see the site of surgery and the opening of the lacrimal sac to the nasal cavity Results: 40 eyes that are the ( Non Mitomycin C group ) were evaluated after 9 months after surgery ,this evaluation is done subjectively and objectively ,38 cases were symptom free and the endoscopic findings showed us opend and clean openings of the fistulae we created .2 cases give history of excessive tearing (go with recurrence ),in this cases , no benefit from syringing, and the endoscopic finding showed fibrous tissue adhesions that come from the axilla of the middle turbinate to the opening of the sac we created and also extends to the nasal septum and surrounding tissues. In the other group of the 37 cases ( Mitomycin C ) group , patients give no symptoms of excessive tearing except 1 case , flexible fibro_optic endonasal endoscopic examination of these patients showed patent orifices created in our surgeries with no adhesion or fibous bands affect the tears passageway.the recurrent epiphoric patient was got no benefit from syringing and the endoscopic findings (this was after 9 monthes of the surgery) showed adhesion bands surround the area near the orifice created , ( really the septum in this case was near the orifice(not attached to it) but our decision during the surgery was not to do septoplasty ) Conclusion: intraoperative Mitomyicin C has little( no significant) effect on the results of DCR surgery.