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Nonlaser endoscopic endonasal dacryocystorhinostomy with adjunctive mitomycin C in nasolacrimal duct obstruction in adults.
Ophthalmology. 2010 May; 117(5):1037-40.O

Abstract

PURPOSE

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.

DESIGN

Retrospective, nonrandomized, noncomparative, case series.

PARTICIPANTS

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.

MAIN OUTCOME MEASURES

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.

Authors+Show Affiliations

Division of Orbital, Ophthalmic Plastic and Reconstructive Surgery, Clinica de Oftalmología de Cali, Universidad del Valle, Cali, Colombia. adolmetsch@mac.com

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20079535

Citation

Dolmetsch, Angela M.. "Nonlaser Endoscopic Endonasal Dacryocystorhinostomy With Adjunctive Mitomycin C in Nasolacrimal Duct Obstruction in Adults." Ophthalmology, vol. 117, no. 5, 2010, pp. 1037-40.
Dolmetsch AM. Nonlaser endoscopic endonasal dacryocystorhinostomy with adjunctive mitomycin C in nasolacrimal duct obstruction in adults. Ophthalmology. 2010;117(5):1037-40.
Dolmetsch, A. M. (2010). Nonlaser endoscopic endonasal dacryocystorhinostomy with adjunctive mitomycin C in nasolacrimal duct obstruction in adults. Ophthalmology, 117(5), 1037-40. https://doi.org/10.1016/j.ophtha.2009.09.028
Dolmetsch AM. Nonlaser Endoscopic Endonasal Dacryocystorhinostomy With Adjunctive Mitomycin C in Nasolacrimal Duct Obstruction in Adults. Ophthalmology. 2010;117(5):1037-40. PubMed PMID: 20079535.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nonlaser endoscopic endonasal dacryocystorhinostomy with adjunctive mitomycin C in nasolacrimal duct obstruction in adults. A1 - Dolmetsch,Angela M, Y1 - 2010/01/15/ PY - 2009/04/17/received PY - 2009/09/17/revised PY - 2009/09/18/accepted PY - 2010/1/19/entrez PY - 2010/1/19/pubmed PY - 2010/5/14/medline SP - 1037 EP - 40 JF - Ophthalmology JO - Ophthalmology VL - 117 IS - 5 N2 - PURPOSE: 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. DESIGN: Retrospective, nonrandomized, noncomparative, case series. PARTICIPANTS: 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. MAIN OUTCOME MEASURES: 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. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/20079535/Nonlaser_endoscopic_endonasal_dacryocystorhinostomy_with_adjunctive_mitomycin_C_in_nasolacrimal_duct_obstruction_in_adults_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(09)01093-8 DB - PRIME DP - Unbound Medicine ER -