J Korean Ophthalmol Soc.  2018 Oct;59(10):899-907. 10.3341/jkos.2018.59.10.899.

Efficacy of Intraoperative Mitomycin C Eye Drops during and after Dacryocystorhinostomy for Canalicular Obstruction

• Choi YJ
• Kim SJ
• Yoo JM
• Seo SW

• KMID: 2422577
• DOI: http://doi.org/10.3341/jkos.2018.59.10.899

Abstract

PURPOSE
This study investigated the efficacy of intraoperative and postoperative mitomycin C eye drops in patients with canalicular obstructions.
METHODS
In total, 46 eyes of 46 patients diagnosed with canalicular obstruction at our hospital between June 2012 and June 2016 were analyzed. Canalicular trephination was done and, after applying 0.02% mitomycin C for 3 minutes on the exposed lacrimal sac during endoscopic dacryocystorhinostomy, the area was washed with 20 mL of saline solution, and a silicon tube was inserted. On postoperative day 1, an antibiotic eye drop was applied; beginning on postoperative day 2, 0.02% mitomycin C eye drops were applied, and 0.5% steroid eye drops were applied. Pre- and postoperative anterior segment optical coherence tomography was used to measure the nasal, central, and lateral tear meniscus heights. The extent of functional improvement was assessed by measuring the degree of tear according to Munk's score, and anatomical improvement was assessed using a syringing test.
RESULTS
The nasal tear meniscus height decreased from 571.64 ± 260.51 µm to 267.16 ± 59.25 µm (p = 0.043); central tear meniscus height from 580.16 ± 186.24 µm to 271.14 ± 45.10 µm (p = 0.018); and lateral tear meniscus height from 480.52 ± 260.23 µm to 220.16 ± 63.79 µm (p = 0.029). The functional success rate was 93.5% (43/46), and the anatomical success rate was 95.7% (44/46).
CONCLUSIONS
Intraoperative and postoperative mitomycin C and steroid eye drops may be an effective treatment for canalicular obstruction patients and should help increase surgical success rates.

Keyword

Dacryocystorhinostomy; Lacrimal canaliculus; Mitomycin C

MeSH Terms

Dacryocystorhinostomy*
Humans
Mitomycin*
Nasolacrimal Duct
Ophthalmic Solutions*
Silicon
Sodium Chloride
Tears
Tomography, Optical Coherence
Trephining
Mitomycin
Ophthalmic Solutions
Silicon
Sodium Chloride

Figure

• 

  Figure 1 Anterior segment optical coherence tomography image of the lower eyelid tear meniscus captured at three points. (A) medial point, the vertical axis of the medial limbus (B) central point, the vertical axis of the corneal center (C) lateral point, the vertical axis of the lateral limbus (D) cross-sectional view. (A–C) arrows indicate vertical line centered at three points. (D) arrow indicates tear meniscus height.

• 

  Figure 2 Improvements of lower eyelid tear meniscus height after intraoperative use of mitomycin C and postoperative mitomycin C eye drops in patients with canalicular obstruction treated with endonasal dacryocystorhinostomy (n = 46, Paired t-test; p<0.05). TMH = tear meniscus height. *Six months after removing silicone tube.

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