Silicone nasolacrimal intubation with mitomycin-C: a prospective, randomized, double-masked study.
OBJECTIVE
To determine if mitomycin-C (MMC) application during silicone intubation (SI) can effectively substitute for dacryocystorhinostomy (DCR) or Jones tube insertion.


METHODS
A prospective, randomized, double-masked study.


METHODS
Twenty-four patients (7 males, 17 females; aged 2-69 years) with 27 eyes (three bilateral cases) with an obstructed lacrimal system who were candidates for DCR or Jones tube.


METHODS
All study patients underwent SI with application in a randomized, double-masked fashion of MMC or placebo, with the former receiving 0.2 mg/ml MMC for 2 minutes before SI.


METHODS
Clinical assessment of tearing and discharge; Schirmer I and II tests at 1, 3, 6, and 12 months; and the need for eventual DCR or Jones tube insertion.


RESULTS
Follow-up ranged from 13 to 23 months (mean, 18 months; median, 17 months). Seven of the 12 eyes in the MMC group and 8 of the 15 eyes in the placebo group had a successful outcome and remained symptom free. The difference was not statistically significant (P = 0.79). Dacryocystorhinostomy or Jones tube was performed in five eyes in the MMC group and in seven eyes in the placebo group 3 to 18 months later; all had successful outcome and no complications. Untoward effects of MMC application included a slit canaliculus and a transient conjunctival injection. A successful outcome using this combined technique does not appear to correlate with age, gender, laterality, and intraoperative bleeding observed at the punctum or for the duration of symptoms.


CONCLUSIONS
Mitomycin-C application during SI did not benefit outcome. Complications from such application were mild and infrequent.
Liu
Don
D
Department of Ophthalmology, University of Missouri, 1 Hospital Drive, Room EC 139, Columbia, MO 65212, USA. LiuD@health.missouri.edu
Bosley
Thomas M
TM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003608:Dacryocystorhinostomy / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007440:Intubation / Q000379:methods*; D007767:Lacrimal Duct Obstruction / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use*; D009301:Nasolacrimal Duct; D011446:Prospective Studies; D012826:Silicone Elastomers; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D012826:Silicone Elastomers; D016685:Mitomycin