بررسي نتايج كاربرد ميتومايسين در عمل داكريوسيستورينوستومي و لزوم نمونه برداري از كيسه اشكي

Results of Intraoperative Mitomycin C Application in Dacryocystorhinostomy and Necessary of Lacrimal Sac Biopsy

Background and Objectives: Mitomycin C can inhibit fibrous tissue growth and scarring over the anastomosed flap. In this article, we present a control study by using mitomycin C to evaluate the effect of mitomycin C over the anastomosed flap. After dacryocystorhinostomy (DCR) the incidence of significant pathology of lacrimal sac is unknown therefore we reviewed our finding to determine the usefulness of routine lacrimal sac biopsy. Materials and Methods: A total of 47 eye of 46 patients diagnosed with primary acquired nasolacrimal duct obstruction were assigned randomly to either a mitomycin C group (23 eye) or a control group (24 eye). The surgical procedures in both groups were exactly the same, except that in the mitomycin C group, mitomycin C was applied (0.3 mg/ml for 3 minutes) to the nasal mucosa and mucosa of the lacrimal sac. Then patients were followed for 12 months. Surgical success was patientʹs satisfaction and lack of tearing. Lacrimal sac biopsies were obtained from all patients. Results: The success rate of DCR with intraoperative mitomycin C was. 87% whereas the success rate without mitomycin C was 83%. The statistical analysis did not show difference between the two groups. No neoplasms, granulomatous inflammation and infection were detected among all specimens from 46 patients. Most lacrimal sac specimens demonstrated chronic inflammatory changes and fibrous. Conclusion: Mitomycin C application (0.3 mg/ml for 3 minutes) during DCR had no beneficial effect on outcome. Complications from such an application were infrequent. We recommend that lacrimal sac biopsy in patients undergoing DCR should be performed only in those with a positive history for systemic disease or an abnormal appearing lacrimal sac during surgery rather than routine biopsy of all patients.