Nonlaser endoscopic endonasal dacryocystorhinostomy with adjunctive mitomycin C in nasolacrimal duct obstruction in adults.
OBJECTIVE
To determine the outcome and safety of nonlaser endonasal dacryocystorhinostomy (NLEN-DCR) with the use of adjunctive mitomycin C (MMC) in congenital, traumatic, and primary acquired nasolacrimal duct obstruction in adults.


METHODS
Retrospective, nonrandomized, noncomparative, case series.


METHODS
One hundred ninety-three consecutive adult patients underwent NLEN-DCR with the use of adjunctive MMC. Thirty-one patients had a simultaneous bilateral procedure performed.


METHODS
All patients underwent a standardized procedure, with an endonasal approach to the lacrimal sac, surgical removal of nasal mucosa, lacrimal bone, and a fragment of the frontal process of the maxilla. The medial wall of the lacrimal sac was removed completely, and a neurosurgical cottonoid soaked in MMC at 0.5 mg/ml was placed at the osteotomy site for 10 minutes. All patients underwent bicanalicular silicone intubation.


METHODS
Resolution of epiphora, absence of discharge, and patency of the ostium confirmed by irrigation at 6 months.


RESULTS
The NLEN-DCR procedure with adjunctive MMC was successful in 212 (95%) cases. The mean follow-up was 18.2 months. Intubation of more than 3 months was associated with a higher rate of obstruction (P<0.00018, Fisher exact test), with 9 eyes of 8 patients losing patency. Age, diagnosis, side operated, or infection at the time of surgery had no influence on the final outcome. No significant complications were encountered.


CONCLUSIONS
Results suggest that NLEN-DCR with MMC is a safe and successful procedure for the treatment of congenital, traumatic, and primary acquired nasolacrimal duct obstruction in adults. It has the advantage of leaving no scar and of preserving the medial canthal structures. It can be performed successfully as a simultaneous bilateral procedure.
Dolmetsch
Angela M
AM
Division of Orbital, Ophthalmic Plastic and Reconstructive Surgery, Clinica de Oftalmología de Cali, Universidad del Valle, Cali, Colombia. adolmetsch@mac.com
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003608:Dacryocystorhinostomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007440:Intubation; D007767:Lacrimal Duct Obstruction / Q000151:congenital; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009301:Nasolacrimal Duct / Q000002:abnormalities / Q000187:drug effects* / Q000293:injuries / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D000477:Alkylating Agents; D016685:Mitomycin