PURPOSE. To evaluate the effects of antiproliferative agents on the fibrous tissue responsible for the failure of external dacryocystorhinostomy at the site of surgical rhinostomy. METHODS. The study group consisted of 60 cases. Patients with primary acquired idiopathic nasolacrimal duct obstruction were divided into three groups according to the agent used. Each group consisted of 20 patients. Mitomycin C was applied to the first group (0.5 mg/ml to 10, 1 mg/ml to 10 cases) and 5-flourouracil to the second group (2.5 mg/ml to 10, 5 mg/ml to 10 cases). The third group consisted of 20 control cases. The mean follow-up period was 15.3 +/- 2.60 (12-18) months. The tissues obtained during the revision of the cases with failure were evaluated by light and electron microscopic examination. RESULTS. External dacryocystorhinostomy failed in four cases. Of these, one was in the first group (0.5 mg/ml mitomycin C), one in the second group (2.5 mg/ml 5-flourouracil), and two were in the control group. Light microscopic examination of the tissues revealed an increase in fibroblastic activity in the control group whereas hypo- and acellular areas were found to be dominant in the groups given antifibroblastic agents. The control group revealed more active fibroblasts with cytoplasms containing numerous organelles in electron microscopic examination. Electron microscopic examination of the cases given antifibroblastic agents revealed fibroblastic cells with nuclear fragmentation, necrosis or pyknosis, while some others had scanty cytoplasms poor in organelles. CONCLUSION. We can conclude that intraoperative antiproliferative agents improve the success rate of external dacryocystorhinostomy.

ÖzetÇalışmamızda pterjium cerrahisinde uygulanan farklı cerrahi teknikler arasında nüks oranlarının araştırılması amaçlandı. Çalışmaya ameliyat sonrası en az 6 ay takibi bulunan, 128 hastanın 130 gözü alındı. Hastalara cerrahi yöntem olarak çıplak sklera bırakılması, intraoperatif MMC (Mitomisin C) uygulaması, geniş tenon eksizyonu ve konjonktival otogreft uygulaması yöntemleri uygulandı. Hastaların yaşı, cinsiyeti, takip süreleri, uygulanan cerrahi prosedür, nüks gelişme zamanları ve komplikasyonlar not edildi. Sonrasında hesaplanan nüks oranları istatistiksel olarak analiz edildi. Ortalama 9,42±3,93 ay takip edilen hastaların %25,4'ünde nüks saptandı. En yüksek nüks oranı %55,2 ile çıplak sklera tekniğinde tespit edildi. Konjonktival otogreft uygulamasında %14,6, intraoperatif MMC uygulamasında %13,5, geniş tenon eksizyonunda %31,3 oranında nüks görüldü. Çıplak sklera bırakılması ile konjonktival otogreft uygulaması ve intraoperatif MMC uygulaması arasında nüks açısından anlamlı fark saptanırken, geniş tenon eksizyonu ile diğer 3 yöntem arasında nüks bakımından farklılık saptanmadı. Çıplak sklera bırakılması diğer yöntemlerden yüksek nüks oranlarına sahiptir. Birbirine yakın düşük nüks oranları mevcut olsa da potansiyel komplikasyonlar göz önüne alındığında konjonktival otogreft yöntemi, intraoperatif MMC uygulamasına tercih edilmelidir. Geniş tenon eksizyonunun diğer yöntemlerle kıyaslanması için geniş vaka grupları ile yapılacak çalışmalara ihtiyaç vardır. Anahtar kelimeler: Mitomisin C; nüks; pterjium AbstractThis study was done to compare the rates of recurrence of pterygium following performed different surgical techniques for treatment. One hundred and thirty eyes of 128 patients were examined following the surgical treatment in our clinic between February 2004-January 2008 with mean follow-up of six months. We performed bare sclera, application of intraoperative MMC (Mitomycin C), wide tenon's membrane excision and conjunctival auto-grafting techniques. The age and sex of the patients and follow-up duration, operation techniques, complications and the recurrence times were noted. Median follow-up was 9,42±3,93 months and the recurrence rate was %25,4. The highest recurrence rate was %55,2 (in the bare sclera technique), the lowest recurrence rate was %13,5 (in the intraoperative MMC technique). It was %14,6 in conjunctival auto-grafting technique group and %31,3 in the complete tenon's membrane excision group. Statistically, the rate of recurrence was meaningful between the bare sclera group and the conjunctival autografting group and between intraoperative MMC group. But the outcomes of the wide tenon's membrane excision group and the other three groups weren't meaningful. Bare sclera technique had the highest recurrence rates. Though, there wasn't meaningful recurrence rates between intraoperative MMC technique and the conjunctival auto-grafting technique, we must prefer the second one because of its lowest complication risks. The wide tenon's membrane excision technique needs some more studies to com...