title: Mitomycin C in revision endoscopic dacryocystorhinostomy: a prospective randomized study.
abstract: BACKGROUND
  Endoscopic dacryocystorhinostomy (EN-DCR) is an effective and safe procedure when treating saccal and postsaccal nasolacrimal duct obstruction. However, sometimes scarring of the rhinostomy site caused by fibrosis may occur, particularly in revision operations.  The application of intraoperative mitomycin C (MMC), an antiproliferative agent, has been introduced as one possible technique to improve the outcome. We conducted a prospective, randomized study to evaluate if the use of MMC improves the success in endonasal revision DCR procedure.
  
  
  METHODS
  Thirty revision EN-DCR procedures were performed during 2004-2010. The patients were randomized into two study groups, according to whether the intraoperative MMC was used or not. The technique of EN-DCR procedure in both groups was the same, but in the MMC group,  at the end of the procedure a piece of tampon soaked in MMC (0.4 mg/mL) was placed into the rhinostoma for 5 minutes. No silicone stents were inserted. The surgical outcome at the 6-month follow-up visit was considered successful if the lacrimal sac irrigation succeeded and if the patients'  symptoms were relieved.
  
  
  RESULTS
  The success rate after revision EN-DCR with MMC was 93% and without MMC was 60%. The overall success rate was 77%. The difference between the two groups was not statistically significant (p = 0.08). The relief of the symptoms between groups  in both the Nasolacrimal Duct Obstruction Symptom Score and ocular symptoms was statistically significant (p = 0.007 and p = 0.02, respectively).
  
  
  CONCLUSIONS
  The results of our study indicate that the application of intraoperative mitomycin C may improve the outcome in  revision EN-DCR.
authors.affiliation: Department of Otorhinolaryngology, Institute of Clinical Medicine, Kuopio University Hospital, and University of Eastern Finland, Finland.
authors.forename: Elina
authors.initials: E
authors.lastname: Penttilä
authors.forename: Grigori
authors.initials: G
authors.lastname: Smirnov
authors.forename: Juha
authors.initials: J
authors.lastname: Seppä
authors.forename: Kai
authors.initials: K
authors.lastname: Kaarniranta
authors.forename: Henri
authors.initials: H
authors.lastname: Tuomilehto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D002921:Cicatrix / Q000209:etiology* / Q000517:prevention & control; D003608:Dacryocystorhinostomy; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006131:Growth Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007430:Intraoperative Care; D007767:Lacrimal Duct Obstruction / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage* / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D006131:Growth Inhibitors; D016685:Mitomycin