Mitomycin-C in dacryocystorhinostomy: From experimentation to implementation and the road ahead: A review

Akshay Gopinathan Nair, Mohammad Javed Ali, Akshay Gopinathan Nair, Mohammad Javed Ali

Abstract

Dacryocystorhinostomy (DCR) is the procedure of choice in patients with epiphora due to primary acquired nasolacrimal duct obstruction. The evolution of surgical tools, fiber-optic endoscopes, effective anesthesia techniques, and the adjunct use of antimetabolites intraoperatively; namely mitomycin-C (MMC) have significantly contributed to the advancement of DCR surgery. MMC is a systemic chemotherapeutic agent derived from Streptomyces caespitosus that inhibits the synthesis of DNA, cellular RNA, and protein by inhibiting the synthesis of collagen by fibroblasts. Even the cellular changes in the human nasal mucosal fibroblasts induced by MMC at an ultrastructural level have been documented. There, however, seems to be a lack of consensus regarding MMC: The dosage, the route of delivery/application, the time of exposure and subsequently what role each of these variables plays in the final outcome of the surgery. In this review, an attempt is made to objectively examine all the evidence regarding the role of MMC in DCR. MMC appears to improve the success rate of DCR.

Figures

Figure 1
Figure 1
(a-c) The sites of injection of intramucosal (nasal mucosa) circumostial mitomycin-C seen endoscopically (sites marked with yellow asterisks). A lacrimal probe has been introduced transcanalicular route and is seen at the ostium
Figure 2
Figure 2
Endoscopic view, the ostium of a 2-year-old child who underwent dacryocystorhinostomy with circumostial mitomycin-C. Note the large ostium, which is unusual given the exuberant healing response commonly seen in the pediatric population

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