Aplicación transoperatoria de mitomicina-C en la dacriocistorrinostomía externa: acuerdos y desacuerdos / Intraoperative application of Mitomycin-C in external dacryocystorhinostomy: agreements and disagreements

RESUMEN Introducción: la dacriocistorrinostomía externa es la técnica más empleada por la mayoría de los cirujanos oculoplásticos para tratar a los pacientes con obstrucción del canal nasolagrimal. Es posible que los galenos cometan algunos errores en este tipo de cirugía, a pesar de los grandes avances en las tecnologías ópticas, las técnicas quirúrgicas y el uso de modernos materiales de intubación. La principal causa de los errores es el cierre de la osteotomía por tejido cicatrizal o de granulación, con la formación de sinequias en la cavidad nasal. La mitomicina C es el antibiótico alquilante más estudiado en la prevención del exceso de cicatrización en el área de la osteotomía; sin embargo, existen acuerdos y desacuerdos entre estudiosos del tema sobre la eficacia, dosis y tiempo de exposición de este medicamento. El papel de cada una de estas variables en el resultado final de la cirugía es controversial. Objetivo: brindar evidencias sobre el papel de la aplicación transoperatoria de la mitomicina C en la dacriocistorrinostomía externa. Métodos: se realizó una revisión de la bibliografía actualizada disponible en idioma español e inglés. Se consultaron los textos completos y resúmenes en las bases de datos: PubMed, Ebsco, Google Académico y Scielo. También se revisaron novedosos artículos en prestigiosas revistas especializadas. Conclusiones: la mayoría de los autores coinciden en que este medicamento contribuye a elevar la tasa de éxito de la dacriocistorrinostomía externa; aunque su aplicación es segura, todavía se estudian algunas variables que mejorarían su eficacia.

ABSTRACT Introduction: external dacryocystorhinostomy is the most used technique by oculoplastic surgeons to treat patient with nasolacrimal duct obstruction. Physicians may make some mistakes in this type of surgery despite great advances in optical technologies, surgical techniques and the use of modern materials for intubation, The main cause of errors is the closure of the osteotomy due to scar tissue or granulation with synechia formation in the nasal cavity. Mitomycin-C is the most studied alkylating antibiotic in the prevention of excessive scarring in the osteotomy area; however, there are some agreements and disagreements among scholars on the efficacy, dosage and time of exposure of this drug. The role of each of these variables in the final outcome of the surgery is controversial. Objective: to provide some evidences about the transoperative application of Mitomycin-C in external dacryocystorhinostomy. Methods: a review of the updated bibliography available in Spanish and English languages was carried out. Complete texts and abstracts were consulted in the databases: PubMed, Ebsco, Google Scholar and Scielo. Novel articles were also reviewed in prestigious specialized journals. Conclusions: must authors agree that this drug appears to improve the success rate of external dacryocystorhinostomy. Although its application is safe, some variables are still being studied that would improve its efficacy.

Effect of levofloxacin gel, tobramycin dexamethasone ointment and lacrimal passage probing on neonatal dacryocystitis / 中国生化药物杂志

Objective To patients with neonatal dacryocystitis underwent left Ofloxacin Gel, Tobramycin and Dexamethasone Ophthalmic Ointment and lacrimal surgery combined with treatment effects were observed.MethodsIn Ningxia Hui Autonomous Region Qingtongxia City People's Hospital during December 2015 to December 2016 for dacryocystitis in 130 cases according to the data analysis, using different treatment schemes were divided into two groups, 65 cases underwent lacrimal surgery as control group, 65 cases and left Ofloxacin Gel, Tobramycin and Dexamethasone Ophthalmic Ointment combined treatment as the observation group, blocking characters and comparison of complications two groups of clinical curative effect, lacrimal duct.ResultsIn the observation group, the total effective probability of 96.92% higher than the control group of 80.00%(P<0.05), and the nasal deformity, nasolacrimal duct, lacrimal bone deformity multiple adhesions or obstruction and lower incidence of membranous obstruction of lacrimal duct is lower than that of control group (P<0.05);the total complication rate in the observation group(3.08%) than the control group(21.54%)low (P<0.05).ConclusionNeonatal dacryocystitis underwent left Ofloxacin Gel, Tobramycin and Dexamethasone Ophthalmic Ointment and lacrimal surgery combined therapy can improve the clinical symptoms and characteristics of lacrimal duct obstruction, and reduce postoperative complications, which may be of clinical promotion and application.

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

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.

Surgical technique and preliminary results of transcanalicular endoscopic lacrimal duct recanalization and balloon dacryoplasty with silicone intubation in Filipino patients with complete nasolacrimal duct obstruction

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe the surgical technique of transcanalicular endoscopic lacrimal duct recanalization (TELDR) with balloon dacryoplasty and silicone intubation in patients with complete nasolacrimal duct obstruction and assess their effectivity.</p> <p style="text-align: justify;"><strong>METHODS:</strong> Ten lacrimal systems from eight patients diagnosed with complete nasolacrimal duct obstruction (NLDO) underwent TELDR and balloon dacryoplasty with silicone intubation.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> All 10 lacrimal systems from eight patients who underwent TELDR and balloon dacryoplasty with silicone intubation had 100% anatomical and functional patency.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> TELDR and balloon dacryoplasty with silicone intubation represents an alternative, minimally invasive technique in the management of complete nasolacrimal duct obstruction.</p>

Transcanalicular diode laser-assisted dacryocystorhinostomy.

Objective: We present a prospective, non-comparative case series study of 126 consecutive diode laser-assisted transcanalicular dacryocystorhinostomy (TCL-DCR) procedures on 122 patients. We analyzed success rate, procedure time and amount of laser energy needed for a 5 mm osteotomy. Materials and Methods: One hundred and twenty-two patients with nasolacrimal duct obstruction were included in the study. The procedure was performed under general anesthesia, and the nasal mucosa was anesthetized. An endoscope was used for examination of the lacrimal pathways. The site of osteotomy was determined with transillumination of the lateral nasal wall. We achieved osteotomy by applying laser energy via an optic fiber. We used a 980 nm diode laser with power of 10 Watts. We inserted a bicanalicular silicone stent as the last step. Success of procedure was absence of epiphora (subjective), or patency of the lacrimal drainage system on irrigation (objective). Results: We performed 126 successive endoscopic laser (EL-DCR) with bicanalicular intubation in 122 patients. The average procedure time was 12 min, and on average 245 Joules of laser energy was needed. The silicone stents were removed three to eight months after surgery. We observed absence of epiphora and a patent nasolacrimal duct on irrigation in 105 out of 126 treated eyes. Eighteen patients had epiphora despite a patent nasolacrimal duct on irrigation. This yields a success rate of 83.3%, with an average follow-up period of 12 months. Conclusions: The 980 nm EL-DCR with bicanalicular intubation is a new contribution to the field of lacrimal surgery. It is a minimally invasive quick procedure yielding a high success rate.

The Surgical Efficacy of External Lacrimal Surgery without Nasal Mucosal Flap

PURPOSE: To evaluate the surgical result of lacrimal surgery with total removal of the nasal mucosal flap. METHODS: Lacrimal surgery was performed in 30 eyes of 26 patients, by external approach without the nasal mucosal flap from February 2001 to August 2002. The surgical method was similar to conventional dacryocystorhinostomy, but the nasal mucosa of the osteotomy site was removed with a No.11 Bard-Parker blade and Westcott scissors. After insertion of a silicone tube, the anterior flap of the lacrimal sac was sutured to the soft tissues around the osteotomy site. Surgical efficacy was evaluated after a follow-up period of 7 22 months (average, 11.5 months). RESULTS: The primary success rate was 96.7% (29/30 eyes). We performed revision of mucosa ostium in the one failed eye, thereby raising the final success rate to 100%. The size of mucosa ostium was 0.7 3.0 mm (average 1.17 mm). CONCLUSIONS: Satisfactory surgical results were obtained without anastomosis of the lacrimal sac or the nasal mucosa during external approach, lacrimal surgery. We suggest that this method is a good surgical procedure in external approach, lacrimal surgery.

Clinical Experience of Lacrimal Surgery

The success rate of endonasal lacrimal surgery have been reported inferior to that of external lacrimal surgery. But nowadays, owing to developement of surgical instrument, such as endoscope, and improvement of surgical skill, better success rates have been reported. We have performed endonasal lacrimal surgery in 36 eyes of 34 patients and external lacrimal surgery in 41 eyes of 36 patients who have had lacriaml pathway obstruction confirmed by dacryocystography. Endonasal lacrimal surgery has been performed with endoscope, fiberoptic light pipe, and conventional lacrimal surgery instruments. Primary success rates are 84.0% in endonasal dacryocystorhinostomy (DCR), 89.5% in external DCR, 81.8% in endonasal conjunctivodacryocystorhinostomy(CDCR), and 90.9% in external CDCR. The rate of postoperative complications are 32.0% in endonasal DCR, 47.4%, in external DCR, 27.3% in endonasal CDCR, and 40.9% in external CDCR. Therefore, in order to increase the success rate of endonasal lacrimal surgery, improvement of surgical technique, use of adequate surgical instrument and careful followup examination for proper management of postoperative complicaitons are considered essential.

Clinical Effecd of Endonasal Lacrimal Surgery

This study was carried out to compare the clinical effect of the endonasal lacrimal surgery done in 75 eyes of the 62 patients with that of the conventional lacrimal surgery done by the same operator in 72 eyes of the 57 patients. The diameter of intranasal ostium was 1.9 +/- 0.4 mm in endonasal approach and 2.6 +/- 1.4 mm in skin approach (p<0.05), respectively. Postoperative hospitalization were 1.7 - 2.5 days shorter in endonasal lacrimal surgery than those of conventional lacrimal surgery (p<0.001). Satisfactory tear drainge was observed in 29 eyes (90.6%) after endonasal dacryocystorhinostomy and in 28 eyes (90.3%) after conventional dacryocystorhinostomy, and 41 eyes (95.3%) revealed astisfactory tear drainge after endonasal conjunctivodacrystorhinostomy and 39 eyes (95.1%) showed good results after conventional conjunctivodacr yocystorhinostomy. In summary, endonasal lacrimal surgery showed no cutaneous scar, less edema and hematoma with short recovery time and similar success rate to the conventional lacrimal surgery. Thus, endonasal lacrimal surgery might be better than conventional lacrimal surgery.