Endoscopic dacryocystorhinostomy not using canalicular silicone intubation tube with and without mitomycin C: a comparative study

Abstract

To determine the outcome and safety of endoscopic dacryocystorhinostomy (EN-DCR) with the use of adjunctive mitomycin C (MMC) in nasolacrimal duct obstruction in adults. In this retrospective, comparative case series, 54 consecutive adult patients underwent EN-DCR. We performed endonasal dacryocystorhinostomy with adjunctive MMC in 28 patients and endonasal dacryocystorhinostomy without MMC in 26 patients. All patients underwent a standardized procedure, with an endonasal approach to the lacrimal sac, surgical removal of nasal mucosa, lacrimal bone, and a fragment of the frontal process of the maxilla. The medial wall of the lacrimal sac was removed completely. In the study group (28 patients), a neurosurgical cottonoid soaked in MMC at 0.5 mg/mL was placed at the osteotomy site for 5 minutes (not using canalicular silicone intubation tube). In the other group (26 patients), standard endonasal dacryocystorhinostomy technique was used without MMC (not using canalicular silicone intubation tube). Main outcome measures were resolution of epiphora, absence of discharge, and patency of the ostium confirmed by irrigation at 6 months. The EN-DCR procedure with adjunctive MMC was successful in 24 (85.71%) cases. The mean follow-up was 14.3 months (8-24 months). No significant complications were encountered. In the control group, the EN-DCR was successful in 19 patients (73.07%). The mean follow-up was 13.2 months (6-24 months). Endoscopic dacryocystorhinostomy with MMC is a safe and successful procedure for the treatment of nasolacrimal duct obstruction in adults.