title: Circumostial injection of mitomycin C (COS-MMC) in external and endoscopic dacryocystorhinostomy: efficacy, safety profile, and outcomes.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of a new technique of circumostial mitomycin C (COS-MMC) injection in dacryocystorhinostomy (DCR) and to evaluate the outcomes.
  
  
  METHODS
  A prospective, interventional consecutive case series involving 110 DCR surgeries performed over a period of 1 year using the COS-MMC technique were evaluated. All patients were operated by a single surgeon (M.J.A.). After fashioning of the mucosal flaps, all patients underwent an intramucosal injection of 0.02% MMC at 4 points (0.1 ml at each point) along the edges of the freshly created ostium. All patients were intubated, and stent removal was done at 12 weeks following the surgery. All patients underwent regular monitoring of the ostium to look for any complications. A minimum follow up of 6 months after stent removal was considered for final analysis. The outcome measures analyzed were anatomical and functional success, complications, and ostium.
  
  
  RESULTS
  The mean age at presentation was 39.91 years. The diagnosis was primary acquired nasolacrimal duct obstruction in 60.9% (67/110) and persistent congenital nasolacrimal duct obstruction in 9.1% (10/110) of the patients. Twenty-six patients were known cases of failed DCR and underwent a revision DCR. Of the total patients, 19.1% (21/110) had a history of acute dacryocystitis, of which, 73% (80/110) of the surgeries were performed by an external approach and 27% (30/110) by endoscopic endonasal route. Anatomical success was noted in 97.3% (107/110) and functional success in 96.4% (106/110). All the 4 failures were due to cicatricial closure of the ostium. None of the patients were noted to have mucosal burns in the area where MMC was injected, and none of the Ostia showed any features of necrosis, infection, or any other complications.
  
  
  CONCLUSIONS
  COS-MMC is a safe and effective adjunctive modality in DCR. No adverse effects on the ostium were noted. The technique appears to be promising for the success of cases with high risk of failures like revision DCR and traumatic secondary acquired nasolacrimal duct obstruction.
authors.affiliation: Dacryology Service, Ophthalmic Plastics Surgery, L.V. Prasad Eye Institute, Hyderabad, Andhra Pradesh, India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kamal
authors.forename: Mohammad Javed
authors.initials: MJ
authors.lastname: Ali
authors.forename: Milind N
authors.initials: MN
authors.lastname: Naik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000477:Alkylating Agents / Q000008:administration & dosage*; D002648:Child; D003131:Combined Modality Therapy; D003608:Dacryocystorhinostomy / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D056965:Injections, Intraocular; D007767:Lacrimal Duct Obstruction / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009301:Nasolacrimal Duct / Q000187:drug effects / Q000601:surgery*; D011446:Prospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin