The safety and efficacy of mitomycin C in endonasal endoscopic laser-assisted dacryocystorhinostomy

Purpose: The adjunctive use of mitomycin C (MMC) in glaucoma and pterygium surgery has been widely published, but there has not been any large long-term study of its use in endonasal endoscopic laser-assisted dacryocystorhinostomy (ELA-DCR). The purpose of this study was to examine the safety and efficacy of the adjunctive use of MMC in this procedure. Methods: A nonrandomized, retrospective, single-masked, interventional case-controlled study was performed wherein 123 consecutive procedures using MMC in ELA-DCR procedures, using the Holmium:YAG laser, were compared with a historical control group consisting of 48 consecutive procedures in which MMC was not used. One surgeon performed all procedures. The two groups were compared with regard to complications as well as success rate. The main outcome measures for success were the resolution of epiphora and patency with lacrimal irrigation. Success rates were analyzed using the Fisher's exact test. The main outcome determinants for complications were the presence or absence of delayed wound healing, wound necrosis, infection, or excessive bleeding. Postoperative follow-up interval ranged from 30 months to 72 months. Results: There were no complications in the group receiving MMC. One case of turbino-septal synechia formation occurred in the non-MMC group. The success rate of the MMC group was 99.2% compared with 89.6% in the control group. This difference (9.6%) was statistically significant using Fisher's exact test (p = 0.007). Conclusion: This study supports the safety and efficacy of the intraoperative use of MMC in endonasal ELA-DCR.