Use of mitomycin C and 5-fluorouracil in external dacryocystorhinostomy

Abstract

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.

Intra-Operative Mitomycin-C as Adjuvant Therapy in External and Endonasal Dacryocystorhinostomy: Systematic Review and Meta-Analysis

“…The characteristics of the eligible studies are summarized in Table 1. Ten studies were conducted in India [4, 11, 21, 22, 30, 33-35, 37, 42], four in Turkey [6,31,32,36], four in China [26,38,39,41], three in Iran [12,23,28], two in Taiwan [8,27], one in Spain [24], one in Saudi Arabia [29], one in Thailand [40], and one in Pakistan [25]. Sample sizes in these studies ranged from 15 to 328 patients.…”

Endoscopic Dacryocystorhinostomy in Acute Dacryocystitis: A Multicenter Case Series

“…It is certainly possible that antecedent chronic dacryocystitis predisposed to surgical failure in this case. It is now the practice of one of the authors (DS) to use intraoperative mitomycin C in all cases of DCR; in cases where an extensive fibrosing reaction is likely; this may be a prudent course of action (Deka et al, 2006;Yalaz et al, 1999).…”

Acquired Nasolacrimal Duct Obstruction

“…Hypo-and acellular areas were identified by light microscopy, and fragmentation and necrosis of the fibroblast nuclei along with scanty cytoplasm poor in organelles were identified by electron microscopy. Tissues from the control group (not treated with antimetabolites at the initial surgery) showed increased numbers of active fibroblasts with cytoplasm containing numerous organelles by light and electron microscopy [81].…”