Outcome of Revision External DCR using Mitomycin C with or without Intubation in Failed Primary DCR
Authors
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Abstract
Objectives: The study evaluates revision dacryocystorhinostomy (DCR) outcomes with intra-operative mitomycin-C, addressing the need for intubation in unsuccessful primary DCR cases. It also examines the safety of mitomycin-C, complications of lacrimal intubation, and factors contributing to primary DCR failure. Methods: This Prospective study was conducted at AIIMS, New Delhi, involving patients with primary DCR failure lasting over 6 months. Adults aged 18 and above willing to participate were included, while exclusion criteria those with certain medical conditions or prior surgeries. The standard external DCR procedure included excising scar tissue and performing a bony osteotomy. Total 40 patients were randomly assigned to two groups: Group 1 (20 patients) underwent revision external DCR with lacrimal intubation and intraoperative mitomycin C treatment, while Group 2 (20 patients) received the same treatment without intubation. Results: Total of 40 adult patients with failed primary dacryocystorhinostomy (DCR) were studied. Mean ages were 37.05 years for Group 1 and 39.70 years for Group 2, with a higher prevalence of females in both groups. Major findings indicated fibrosis around the bony ostium, with some patients lacking an ostium. Post-operative complications like foreign body sensation were more common in Group 1 during tube placement, but outcomes post-tube removal were similar for both groups. Anatomical success was 100% for Group 1 and 95% for Group 2 at four months, while functional success was 90% for Group 1 and 80% for Group 2, with no significant differences overall indicating comparable results for both techniques in anatomical and functional success. Conclusion: Revision external DCR with Mitomycin C achieved 97.5% anatomical and 85% functional success rates in previously unsuccessful cases. Fibrosis was the primary reason for failure. Silicone tube intubation led to a slightly higher success rate (100% anatomical, 90% functional) compared to non-intubation, though differences were not statistically significant. Post-operative complications were more frequent with intubation but resolved after tube removal. The procedure is viewed as safe, reliable, and effective.
##plugins.themes.bootstrap3.article.details##
Copyright (c) 2025 Dr. Brijesh Kumar, Prof. Neelam Pushker, Dr. Dinesh Kumar Yadav, Dr. Kumari Rachna
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.
Dr. Brijesh Kumar, Assistant Professor, Department of Ophthalmology, Maharshi Vishwamitra Autonomous State Medical College, Ghazipur, Uttar Pradesh, India.
Assistant Professor, Department of Ophthalmology, Maharshi Vishwamitra Autonomous State Medical College, Ghazipur, Uttar Pradesh, India.
Prof. Neelam Pushker, Professor, Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.
Professor, Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.
Dr. Dinesh Kumar Yadav, Assistant Professor, Department of Ophthalmology, Maharshi Vishwamitra Autonomous State Medical College, Ghazipur, Uttar Pradesh, India.
Assistant Professor, Department of Ophthalmology, Maharshi Vishwamitra Autonomous State Medical College, Ghazipur, Uttar Pradesh, India.
Dr. Kumari Rachna, Assistant Professor, Department of Ophthalmology, Maharshi Vishwamitra Autonomous State Medical College, Ghazipur, Uttar Pradesh, India.
Assistant Professor, Department of Ophthalmology, Maharshi Vishwamitra Autonomous State Medical College, Ghazipur, Uttar Pradesh, India.
[1] Mills DM, Meyer DR, Acquired nasolacrimal duct obstruction. Otolaryngol Clin North Am. 2006 Oct;39(5):979-99
[2] Mandeville JT,Woog JJ, Obstruction of the lacrimal drainage system. Curr Opin Ophthalmol, 2002;13(5):303–9
[3] Tanenbaum M, Lacrimal drainage system disorders: diagnosis and treatment. In: McCord CD Jr, Tanenbaum M, Nunery WR(eds), Oculoplastic Surgery, 3rd edn, New York: Raven Press, 1995; 341–77.
[4] Toti A. Nuovometodoconservatore di cura radicle dellesuppurazonicroniche del saccolacrimale (Dacriocistorinostomia). Clin ModFirenze 1904;10:385–7.
[5] Karim R, Ghabrial R, Lynch T, Tang B, A comparison of external and endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal ductobstruction. Clin Ophthalmol. 2011;5:979-89. Epub 2011 Jul 12.
[6] Ben Simon GJ, Joseph J, Lee S, Schwarcz RM, McCann JD, Goldberg RA. External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center. Ophthalmology. 2005 Aug;112(8):1463-8.
[7] Hartikainen J, Antila J, Varpula M, Puukka P, Seppä H, Grénman R. Prospective randomized comparison of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy. Laryngoscope. 1998 Dec;108(12):1861-6.
[8] Linberg JV, McCormick SA. Primary acquired nasolacrimal duct obstruction: A clinicopathologic report and biopsy technique. Ophthalmology 1986;93:1055.
[9] Tsirbas A, Davis G, Wormald PJ. Revision dacryocystorhinostomy: A comparision of endoscopic and external technique. Am J Rhinol 2005 may-Jun;19(3):322-5
[10] Nam Ju Kim, Jong Hyun Kim, Sang Won Hwang, Ho Kyung Choung, Yong Jae Lee, Sang In Khwarg. Lacrimal Silicone Intubation for Anatomically Successful but Functionally Failed External Dacryocystorhinostomy: Korean Journal of Ophthalmology 21(2):70-73, 2007
[11] Seyhmus Ari, Abdullah Kursat Cingu, Alparslan Sahin Ramazan Gun, Vefa Kinis, Ihsan Caca. Outcomes of revision external dacryocystorhinostomy and nasal intubation by bicanalicular silicone tubing under endonasal endoscopic guidance: Int J Ophthalmol. 2012;(2)238-241
[12] Palmer SS. Mitomycin-C as adjunct chemotherapy with trabeculectomy. Ophthalmology 1991;98:317-21
[13] Bergstrom TJ, Wilkinson WS, Skuta GL.The effects of subconjunctival mitomycin-C on glaucoma filtration surgeryin rabbits. Arch Ophthalmol 1991;109:1725-30.
[14] Kupin TH, Juzych MS, Shin DH, et al. Adjunctive mitomycinC in primary trabeculectomy in phakic eyes. Am J Ophthalmol1995;119:30–9.
[15] Wilson MW, Hungerford JL, George SM, Madreperla SA. Topical mitomycin-C for the treatment of conjunctival and corneal epithelial dysplasia and neoplasia. Am J Ophthalmology 1997;124:303-11
[16] Kao SC, Liao CL, Tseng JH, Chen MS, Hou PK. Dacryocystorhinostomy with intraoperative mitomycin C. Ophthalmology. 1997 Jan;104(1):86-91.
[17] You YA, Fang CT, Intraoperative mitomycin C in dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2001 Mar;17(2):115-9
[18] Deka A, Bhattacharjee K, Bhuyan SK, et al., Effect of mitomycin C on ostium in dacryocystorhinostomy. Clin Experiment Ophthalmol, 2006 ;34 (6):557–6.
[19] Feng YF, Yu JG, Shi JL, Huang JH, Sun YL, Zhao YE. A meta-analysis of primary external dacryocystorhinostomy with and without mitomycin C. Ophthalmic Epidemiol. 2012 Dec;19(6):364-70.
[20] Cheng Shi-ming, Feng YF, Xu L, Li Y, Huang J-h. Efficacy of Mitomycin C in Endoscopic Dacryocystorhinostomy: A Systematic Review and Meta-Analysis. PLoS ONE 2013;8(5): e62737.
[21] Anderson RL, Edwards JJ. Indications, complications and results with silicone stents. Ophthalmology. 1979 Aug;86(8):1474-87
[22] Tabatabaie SZ, Heirati A, Rajabi MT, Kasaee A. Silicone intubation with intraoperative mitomycin C for nasolacrimal duct obstruction in adults: A prospective, randomized, double-masked study. Ophthal Plast Reconstr Surg. 2007 Nov-Dec;23(6):455-8
[23] Ari S et al. Outcomes of revision external dacryocystorhinostomy and nasal intubation by bicanicular silicone tubing under endonasal endoscopic guidance. Int J Ophthalmol,2012;(2):238-41.
[24] Allen K, Berlin AI. Dacryocystorhinostomy failure: association with nasolacrimal silicone intubation. Ophthalmic Surg 1989;20:486-489.
[25] Walland MJ, Rose JE. The effect of silicone intubation on failure and infection rates after dacryocystorhinostomy. Ophthalmic Surg 1994;25:597-600
[26] McMurray CJ, McNab AA, Selva D. Late failure of dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2011 Mar-Apr;27(2):99-101.
[27] Elmorsy SM, Fayk HM. Nasal endoscopic assessment of failure after external dacryocystorhinostomy. Orbit. 2010 Aug;29(4):197-201.
[28] Ali MJ, Psaltis AJ, Wormald PJ. Long-term outcomes in revision powered endoscopic dacryocystorhinostomy. Int Forum Allergy Rhinol. 2014Dec;4(12):1016-9.
[29] Kim JH, Shin JH, Song HY, et al., Long-term results and factors affecting patency after removal of nasolacrimal stents, J VascInterv Radiol, 2006;17(7):1125–30.
[30] Rosen N, Sharir M, Moverman DC, Rosner M. Dacryocystorhinostomy with silicone tubes: evaluation of 253 cases. Ophthalmic Surg. 1989 Feb; 20(2): 115–119.
[31] Can I, Gultan E, Yildiz I, Gulcan K. Evaluation of 500 dacryocystorhinostomy. T Klin J Ophthalmol. 1995;59-62
[32] El Guindy A,Dorgham A, Ghoraba M.Endoscopic revision surgery for recurrent epiphora occurring after external dacryocystorhinostomy: Ann Otol Rhinol Laryngol. 2000 Apr;109 (4):425
[33] Imtiyaz A. Lone, Abdul Wahab, Sheikh Sajjad Ahmed, Reyaz A. Untoo. Repeat DCR with silicone Tube Intubation: A Prospective study. JK SCIENCE Vol 6 No.2, April-June 2004
[34] Yildirim C, Yaylali V, Esme A, Ozden S. Long-term results of adjunctive use of mitomycin C in external dacryocystorhinostomy. Int Ophthalmol. 2007 Feb;27(1):31-5.
[35] Penttilä E, Smirnov G, Seppä J, Kaarniranta K, Tuomilehto H. Mitomycin C in revision endoscopic dacryocystorhinostomy: a prospective randomized study. Am J Rhinol Allergy. 2011 Nov-Dec;25(6):425-8. doi: 10.2500/ajra.2011.25.3676. PMID: 22185749.
[36] Gorgulu O et al. Adjunctive use of mitomycin-C in endoscopic revision Dacryocystorhinostomy.B-ENT.2012;(2):123-6
[37] Ragab SM, et al. Mitomycin-C enhance revision endoscopic dacryocystorhinostomy:A prospective randomized controlled trial. Otolaryngol Head Neck Surgery.2012 May 29