Meta-analysis of the Adjunctive Use of Mitomycin C in Primary and Revision, External and Endonasal Dacryocystorhinostomy. (August 2014)

• Record Type: Journal Article
• Authors: Xue, Kanmin; Mellington, Faye E.; Norris, Jonathan H.
• Is Part Of: Orbit. Volume 33:Number 4(2014)
• Page Start: 239
• Page End: 244
• Publication Date: 2014-08
• Subjects: Eye-sockets -- Surgery -- Periodicals; Eye-sockets -- Diseases -- Periodicals; Orbit -- surgery -- Periodicals; Orbital Diseases -- Periodicals; 617.7
• DOI: 10.3109/01676830.2013.871297
• Languages: English
• ISSNs: 0167-6830

Abstract

<abstract> <title>Abstract</title> <p> <italic>Purpose</italic>: To determine whether application of the anti-proliferation agent, mitomycin C (MMC), to the osteotomy site during dacryocystorhinostomy (DCR) surgery increases surgical success rates.</p> <p> <italic>Method</italic>: We conducted a comprehensive meta-analysis of randomised controlled clinical studies relating to the adjunctive use of MMC in primary and revision, as well as external (EX-DCR) and endonasal DCR (EN-DCR).</p> <p> <italic>Results</italic>: 15 studies met our inclusion criteria with a total of 850 DCR procedures. The mean concentration of MMC used was 0.3 mg/ml (range 0.02–0.75 mg/ml) and mean duration of application 18 min (range 2–30 min). MMC significantly reduced the failure rate of primary EX-DCR (risk ratio, RR, 0.51; 95% confidence interval, CI, 0.31–0.86) and revision EN-DCR (RR 0.43; 95% CI 0.21–0.89). The adjunctive use of MMC in primary EN-DCR, however, did not confer a significant reduction in failure rate compared with control (RR 0.94; 95% CI 0.44–2.04). We found a deficiency of evidence regarding the potential benefit of MMC in revision EX-DCR. Only two cases of adverse effects relating to the use of MMC were reported among the studies, both of which related to delayed wound healing.</p> <p> <italic>Conclusions</italic>: Application of MMC to the osteotomy site is a safe and effective way of increasing surgical success rate in primary EX-DCR and revision EN-DCR, but does not provide any significant benefit in primary EN-DCR. Further studies are required to evaluate the potential effect of MMC in revision EX-DCR.</p> </abstract>