Topical application of mitomycin-C in endoscopic dacryocystorhinostomy

Endoscopic dacryocystorhinostomy (DCR) is a well-established alternative to external DCR for treatment of obstruction of the lacrimal pathway and has a success rate of up to 95% in primary cases. Despite the benefits of using an endoscopic approach, including enhanced intranasal access to the lacrimal drainage system, there still exists a significant failure rate, particularly in revision procedures. As these failures are mainly due to obstructive postoperative adhesions, intraoperative adjuncts that prevent or minimize scarring should enhance the success rate. Endoscopic DCR was performed with intraoperative topical application of mitomycin-C, an antimetabolite often used in ophthalmologic procedures to reduce scarring and formation of adhesions following surgery. The procedure was successful in 7 of 8 instances, with a follow-up of 3 to 27 months. In one procedure, obstruction recurred 10 weeks after surgery. We feel that the results of this small series are encouraging and that further studies are warranted to determine the effectiveness of mitomycin-C as an adjunct to endoscopic DCR.