Analysis of efficacy of intraoperative mitomycin C in external dacryocystorhinostomy

Introduction: The success of dacryocystorhinostomy (DCR) depends upon the patency of the lacrimal passage following the procedure. Mitomycin C has a wide application in Ophthalmology. In this present study, conventional external DCR was compared with external DCR were intra operative Mitomycin C was used, in order to prevent fibrosis at the osteotomy site following the procedure. Material and Methods: There were 40 patients in this study who were divided into 2 groups. In group A, MMC was used intraoperatively at the osteotomy site for a period of five minutes. In Group B, Conventional External DCR was done without using an adjuvant. The study population included patients with acquired naso lacrimal duct obstruction . After the surgery, patients were assessed at 1 week, 1, 3 and 6 month respectively. Results: The mean age of the study group was 40.29+/-9.53 years. Patients in both the groups were followed up regularly. Postoperatively at 6 month of visit, it was found that 1 (5%) out of 20 patients in Group A (MMC) and 4 patients (20%) among 20 in Group B(Conventional) reported with symptoms of watering of eyes and on examination had a high tear meniscus height, thereby had a non-patent lacrimal drainage system following surgery. On comparison there was a statistically significant difference between the two groups with the P value of 0.001. It was revealed that success rate was better in MMC group when compared with the Conventional group. Introduction Dacryocystorhinostomy (DCR), can be done externally or endonasally. It is a highly successful procedure with a success rate of more than 80%. The patency of lacrimal passage following the surgery determines the outcome of this procedure. Endonasal and external DCR was first described by Caldwell and Toti. Eventually various modifications has been done which significantly led to the advancement of DCR surgery. Following dacryocystorhinostomy the osteotomy site gets blocked due to formation of adhesions which is the major cause of failure of this procedure in most of the patients. This has been attributed to fibroblast proliferation which could lead to unsatisfactory results. Introduction of antifibrotics like Mitomycin C (MMC) has reformed ophthalmology surgeries including dacrocystorhinostomy, pterygium and glaucoma procedures. Mitomycin C obtained from soil bacterium Streptomyces caespitosus which is an antineoplastic and antiproliferative agent. It acts as a deoxyribonucleic acid cross-linker, which inhibits fibroblast proliferation. It is used in medicine as a chemotherapeutic agent. It has a wide application in Ophthalmology because of its modulatory effects on wound healing. This study helps us to evaluate the role of MMC in maintaining the postoperative patency of naso lacrimal passage. Materials and Methods A prospective study from January 2018 to June 2018 held in a tertiary hospital. The total study population was 40 patients. There were 2 groups, group A (intra operative MMC group) and group B (Conventional) each comprised of 20 patients. The inclusion criteria were patients diagnosed with primary acquired naso lacrimal duct obstruction. Patients with acute dacryocystitis, obstruction secondary to canalicular obstruction, trauma or burns to the eye, malposition of puncta, mass lesion in the medial eyelid or lacrimal sac, lid laxity, significant nasal pathology, patients with anemia(Hb <7gm%) and with deranged coagulation profile were excluded from the study. All patients underwent a comprehensive examination which included slit lamp evaluation for a detailed assessment of ocular adenexa and external ocular surface lacrimal sac syringing was done and the outflow was assessed. A standard nasal examination was performed to rule out pathologies (septal deviation, middle turbinate hypertrophy, nasal polyps) that would affect the surgery. External dacryocystorhinostomy was done under local anaesthesia. In order to prepare Mitomycin C (concentration of 0.2mg/ml), Article Info Received: 22th February, 2019 Accepted: 8th May, 2019 Published Online: 9th September, 2019