Mitomycin C-enhanced revision endoscopic dacryocystorhinostomy: a prospective randomized controlled trial

Area of Science:

• Ophthalmology
• Oculoplastics
• Surgical Innovation

Background:

• Primary endoscopic dacryocystorhinostomy (DCR) can fail due to anatomical issues and scar tissue formation.
• Revision endoscopic DCR aims to restore nasolacrimal duct patency.
• The role of mitomycin C in enhancing revision DCR outcomes requires further investigation.

Purpose of the Study:

• To evaluate the safety and efficacy of mitomycin C-enhanced revision endoscopic DCR.
• To identify common causes of failure after primary endoscopic DCR.

Main Methods:

• A randomized controlled trial involving 76 patients undergoing revision endoscopic DCR.
• Patients were randomized to receive either mitomycin C application or no mitomycin C during the procedure.
• Outcomes assessed included subjective improvement, ostium patency, and complications.

Main Results:

• Failure in primary DCR was primarily attributed to nasolacrimal stoma reclosure (synechia) and suboptimal bony window creation.
• No significant difference in success rates or adverse events was observed between mitomycin C and non-mitomycin C groups.
• The mitomycin C group showed a longer operative time but required fewer debridement sessions.

Conclusions:

• Recurrent obstruction after primary endoscopic DCR is mainly due to stomal reclosure and bony window issues.
• Mitomycin C does not enhance the success rate of revision endoscopic DCR.
• Mitomycin C may benefit patients with limited follow-up by improving healing and reducing debridement needs.