Efficacy of Intraoperative Mitomycin C Eye Drops during and after Dacryocystorhinostomy for Canalicular Obstruction

Yu-Jin Choi; Seong Jae Kim; Ji Myong Yoo; Seong Wook Seo

doi:10.3341/jkos.2018.59.10.899

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Choi, Kim, Yoo, and Seo: Efficacy of Intraoperative Mitomycin C Eye Drops during and after Dacryocystorhinostomy for Canalicular Obstruction

Original Article

Journal of the Korean Ophthalmological Society 2018; 59(10): 899-907.

Published online: 17 October 2018

DOI: https://doi.org/10.3341/jkos.2018.59.10.899

Efficacy of Intraoperative Mitomycin C Eye Drops during and after Dacryocystorhinostomy for Canalicular Obstruction

Yu-Jin Choi, MD¹, Seong Jae Kim, MD, PhD^1,², Ji Myong Yoo, MD, PhD^1,², Seong Wook Seo^1,²

¹Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea.

²Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea.

Address reprint requests to Seong Wook Seo, MD, PhD. Department of Ophthalmology, Gyeongsang National University Hospital, #79 Gangnam-ro, Jinju, 52727 Korea. Tel: 82-55-750-8171, Fax: 82-55-758-4158, stramast@naver.com

Received 15 March 2018 Revised 29 June 2018 Accepted 26 September 2018

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study investigated the efficacy of intraoperative and postoperative mitomycin C eye drops in patients with canalicular obstructions.

Methods

In total, 46 eyes of 46 patients diagnosed with canalicular obstruction at our hospital between June 2012 and June 2016 were analyzed. Canalicular trephination was done and, after applying 0.02% mitomycin C for 3 minutes on the exposed lacrimal sac during endoscopic dacryocystorhinostomy, the area was washed with 20 mL of saline solution, and a silicon tube was inserted. On postoperative day 1, an antibiotic eye drop was applied; beginning on postoperative day 2, 0.02% mitomycin C eye drops were applied, and 0.5% steroid eye drops were applied. Pre- and postoperative anterior segment optical coherence tomography was used to measure the nasal, central, and lateral tear meniscus heights. The extent of functional improvement was assessed by measuring the degree of tear according to Munk's score, and anatomical improvement was assessed using a syringing test.

Results

The nasal tear meniscus height decreased from 571.64 ± 260.51 µm to 267.16 ± 59.25 µm (p = 0.043); central tear meniscus height from 580.16 ± 186.24 µm to 271.14 ± 45.10 µm (p = 0.018); and lateral tear meniscus height from 480.52 ± 260.23 µm to 220.16 ± 63.79 µm (p = 0.029). The functional success rate was 93.5% (43/46), and the anatomical success rate was 95.7% (44/46).

Conclusions

Intraoperative and postoperative mitomycin C and steroid eye drops may be an effective treatment for canalicular obstruction patients and should help increase surgical success rates.

Keywords: Dacryocystorhinostomy, Lacrimal canaliculus, Mitomycin C

Figures and Tables

Figure 1

Anterior segment optical coherence tomography image of the lower eyelid tear meniscus captured at three points. (A) medial point, the vertical axis of the medial limbus (B) central point, the vertical axis of the corneal center (C) lateral point, the vertical axis of the lateral limbus (D) cross-sectional view. (A–C) arrows indicate vertical line centered at three points. (D) arrow indicates tear meniscus height.

Figure 2

Improvements of lower eyelid tear meniscus height after intraoperative use of mitomycin C and postoperative mitomycin C eye drops in patients with canalicular obstruction treated with endonasal dacryocystorhinostomy (n = 46, Paired t-test; p<0.05). TMH = tear meniscus height. ^*Six months after removing silicone tube.

Table 1

Patients characteristics

Values are presented as mean ± standard deviation (SD) unless otherwise indicated.

R = right; L = left.

Table 2

Preoperative and postoperative Munk's score

Values are presented as number (%). ‘0’ means ‘no epiphora’. ‘1’ means ‘occasional epiphora requiring dabbing with a tissue or handkerchief less than twice a day’. ‘2’ means ‘epiphora requiring dabbing two to four times a day’. ‘3’ means ‘epiphora requiring dabbing five to ten times a day’. ‘4’ means ‘epiphora requiring dabbing more than ten times a day or constant tearing’.

^*6 months after removing silicone tube.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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