[Mitomycin C after endoscopic endonasal dacryocystorhinostomy]

Area of Science:

• Ophthalmology
• Otolaryngology
• Surgical Innovation

Background:

• Mitomycin-C (MMC) is commonly used to prevent scarring after endoscopic endonasal dacryocystorhinostomy (EEDCR).
• The standard topical application of MMC during EEDCR shows questionable effectiveness due to its application timing.

Purpose of the Study:

• To evaluate the efficacy of a novel administration route for Mitomycin-C (MMC) in endoscopic endonasal dacryocystorhinostomy (EEDCR).
• To assess the safety and clinical effectiveness of intraoperative MMC injection into the nasal cavity and lacrimal sac mucosa.

Main Methods:

• Eighty-six patients (95 cases) with primary acquired nasolacrimal duct obstruction underwent P.J. Wormald modification of EEDCR.
• Patients were divided into two groups: Group 1 received intra-nasal and lacrimal sac mucosal MMC injection, while Group 2 received standard topical MMC application.
• Tissue and blood samples were analyzed for MMC concentration, and clinical outcomes were assessed at 14±5 months post-surgery.

Main Results:

• Immediate post-injection MMC tissue concentrations in Group 1 were 390±10 µg/g, decreasing to 120±20 µg/g after 30 minutes.
• No MMC was detected in Day 1 tissue samples or any blood samples, indicating minimal systemic absorption.
• Clinical success rates were significantly higher in Group 1 (97.9%) compared to Group 2 (87.2%).

Conclusions:

• Intraoperative injection of Mitomycin-C (MMC) into the nasal cavity and lacrimal sac mucosa is clinically effective for preventing scarring in EEDCR.
• This new administration route demonstrates a favorable safety profile with no detectable systemic absorption.
• The findings support the recommendation of this innovative MMC delivery method for routine clinical practice in EEDCR.