title: Safety and efficacy of adjunctive intranasal mitomycin C and triamcinolone in endonasal endoscopic dacryocystorhinostomy.
abstract: One of the common causes of failure in dacryocystorhinostomy for nasolacrimal duct obstruction (NLDO) is mucosal scarring and fibrosis around the ostium. Steroid and mitomycin C (MMC) can potentially reduce scarring by their action on the inflammatory and proliferative phase of wound healing, respectively. The purpose of this study is to evaluate the safety and efficacy of combined usage of adjunctive MMC and intranasal triamcinolone (TA) in endonasal endoscopic dacryocystorhinostomy (EE-DCR). This is a retrospective interventional case series. All patients underwent mechanical EE-DCR in two regional hospitals in Hong Kong from January 2005 to December 2006 were included. All received intraoperative MMC application for 5 min and gelfoam soaked with TA onto the ostium. Main outcome measures include the anatomical and functional success rate at follow-up at least 6 months after operation. Other outcomes include complications occurred during and after operation. A total of 73 EE-DCR were performed in 69 patients. Three patients had simultaneous bilateral DCR; one had sequential DCRs for both sides. At the last follow-up, anatomical success was achieved in 68 cases (93 %) and both anatomical with functional success in 67 cases (92 %). No major complication was observed. Minor complications included asymptomatic mucosal adhesion between the nasal septum and lateral nasal wall in one patient and moderate secondary hemorrhage in another. EE-DCR with adjunctive MMC and TA is a safe and successful procedure for the treatment of NLDO.
authors.affiliation: Department of Ophthalmology & Visual Sciences, University Eye Center, 3/F, Hong Kong Eye Hospital, The Chinese University of Hong Kong, 147K, Argyle Street, Kowloon, Hong Kong SAR, China.
authors.forename: Emmy Y
authors.initials: EY
authors.lastname: Li
authors.affiliation: Department of Ophthalmology & Visual Sciences, University Eye Center, 3/F, Hong Kong Eye Hospital, The Chinese University of Hong Kong, 147K, Argyle Street, Kowloon, Hong Kong SAR, China. acocheng@gmail.com.
authors.forename: Andy C
authors.initials: AC
authors.lastname: Cheng
authors.affiliation: Department of Ophthalmology & Visual Sciences, University Eye Center, 3/F, Hong Kong Eye Hospital, The Chinese University of Hong Kong, 147K, Argyle Street, Kowloon, Hong Kong SAR, China.
authors.forename: Alex C
authors.initials: AC
authors.lastname: Wong
authors.affiliation: Department of Ophthalmology & Visual Sciences, University Eye Center, 3/F, Hong Kong Eye Hospital, The Chinese University of Hong Kong, 147K, Argyle Street, Kowloon, Hong Kong SAR, China.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Sze
authors.affiliation: Department of Ophthalmology & Visual Sciences, University Eye Center, 3/F, Hong Kong Eye Hospital, The Chinese University of Hong Kong, 147K, Argyle Street, Kowloon, Hong Kong SAR, China.
authors.forename: Hunter K
authors.initials: HK
authors.lastname: Yuen
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003608:Dacryocystorhinostomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007767:Lacrimal Duct Obstruction / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009301:Nasolacrimal Duct / Q000601:surgery; D012189:Retrospective Studies; D014221:Triamcinolone / Q000008:administration & dosage*
chemical_list: D000477:Alkylating Agents; D000893:Anti-Inflammatory Agents; D014221:Triamcinolone; D016685:Mitomycin
keywords: Endoscopic dacryocystorhinostomy; Mitomycin C; Nasolacrimal duct obstruction; Triamcinolone