Double bicanalicular silicone intubation versus single intubation with mitomycin C in conjunction with canaliculo-dacryocystorhinostomy for the management of common and distal canalicular obstruction

Abstract

Introduction Canalicular obstruction is one of the most difficult lacrimal conditions to treat and conjunctivo-dacryocystorhinostomy with a Jones tube is the standard treatment with a high rate of anatomic success, but with a relatively high rate of complications. Canaliculo-dacryocystorhinostomy (canaliculo-DCR) was performed for the management of distal and common canalicular obstruction, and the results depend on the distance of obstruction from the lacrimal sac; restenosis of the canaliculus around the silicone tube is the most common reason for the failure of canaliculo-DCR. Objective The aim of this study was to examine the effect of two separate adjunctive methods used in conjunction with canaliculo-DCR: the use of double intubation of the canaliculi and the use of single intubation plus administration of intraoperative mitomycin C 0.2 mg/ml in cases with membranous and fibrous obstruction of the common and distal canaliculi. Design This prospective nonrandomized comparative interventional case-series study was carried out in the Ophthalmology Department, Minia University Hospital, in the period from March 2009 to December 2011. Patients and methods One hundred and twenty-eight eyes of 109 patients were studied. All cases had distal or common canalicular obstruction with at least 8 mm of patent proximal canaliculi. Canaliculo-DCR operations were carried out. After intraoperative identification of the type of obstruction, membranous or fibrous, we divided the patients into four groups: group 1 included 23 patients with membranous obstruction who received double silicone tubes, group 2 included 23 patients with membranous obstruction who received a single tube plus intraoperative mitomycin C, group 3 included 41 patients with fibrous obstruction who received double silicone tubes, and group 4 included 41 patients with fibrous obstruction who received a single tube plus intraoperative mitomycin C. Silicone tubes were removed after 6 months and patients were followed up monthly for at least another 6 months with evaluation of the patency of the lacrimal passages subjectively and objectively. Results After a mean follow-up of 18.90 months, 79.7% of the patients showed successful results. Membranous groups (group 1 and 2) had an 86.9% success rate, which is higher than that of patients in fibrous groups (75.6%). Patients in group 1 had a lower success rate (82.6%) than patients in group 2 (91.3), but patients in group 3 had a higher success rate (80.5%) than patients in group 4 (70.7%); however, these differences were not statistically significant ( P = 0.6 and 0.4, respectively). Patients who received double silicone tubes (group 1and 3) had a success rate of 81.2%, whereas only 78.1% of the patients who received a single tube plus mitomycin C (group 2 and 4) achieved successful results Conclusion Mitomycin C with single intubation is better than double intubation in case of membranous obstruction of the common canaliculus, whereas double intubation is superior to mitomycin C with single intubation in case of fibrous obstruction of the distal and common canaliculus.