Objective: To assess the efficacy and safety of local application of intraoperative mitomycin C (MMC) at osteotomy site in primary external dacryocystorhinostomy (EX-DCR).
Methods: A comprehensive literature search of Cochrane Library, PubMed and EMBASE to identify relevant trials comparing EX-DCR with MMC (MMC group, from 0.2 to 1.0 mg/mL) and without MMC (control group). A total of 9 randomized controlled trials (RCTs) were selected and a meta-analysis was performed on the result of success rates, which were defined as patency of the nasolacrimal canal and symptomatic improvement. Statistical analysis was performed using RevMan 5.0 software.
Results: The 9 RCT reporting on a total of 562 DCRs including patients lying in the age range of 30 to 57 years were taken for the meta-analysis. However, the total number of males and females could not be found as only 4 RCTs reported on this aspect. There was significantly higher success rate in the MMC group in comparison with control group (odds ratio [OR] 2.11; 95% confidence interval [CI] 1.19 to 3.74; P = 0. 01). In 2 RCTs included, the mean osteotomy size at postoperative 6 months was reported significantly larger in the MMC group than in control group (about 27 mm2 in MMC group versus about 12 mm2 in control group in first study and about 22 mm2 in MMC group versus about 18 mm2 in control group in second study) (p < 0.005). No intraoperative or postoperative complications except two cases with delayed healing of the external skin wound were recorded in MMC group.
Conclusion: Intraoperative MMC application seems to be a safe adjuvant that could reduce the closure rate of the osteotomy after primary EX-DCR. Further well-organized, prospective, randomized studies involving larger patient numbers divided into subgroups for different concentrations of locally applied MMC are warranted. |
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