A Meta-analysis of Primary External Dacryocystorhinostomy With and Without Mitomycin C

Abstract

Objective: To assess the efficacy and safety of local application of intraoperative mitomycin C (MMC) at the osteotomy site in primary external dacryocystorhinostomy (EX-DCR).

Methods: A comprehensive literature search of the Cochrane Library, PubMed and Embase was undertaken to identify relevant trials comparing EX-DCR with MMC (MMC group, from 0.2–1.0 mg/mL) and without MMC (control group). A total of nine randomized controlled trials (RCTs) were selected and a meta-analysis performed on the results 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: Nine RCTs reporting on a total of 562 DCRs including patients in the age range 30–57 years were included in the meta-analysis. However, the total number of males and females could not be determined as only four RCTs reported on this aspect. There was a significantly higher success rate in the MMC group in comparison with the control group (odds ratio, OR, 2.11; 95% confidence interval, CI, 1.19–3.74, P = 0. 01). In two RCTs, the mean osteotomy size 6 months postoperatively was significantly larger in the MMC group than in the control group (about 27mm² in the MMC group versus about 12mm² in the control group in the first study, and about 22mm² in the MMC group versus about 18mm² in the control group in the second study, P < 0.005). No intraoperative or postoperative complications except two cases with delayed healing of the external skin wound were recorded in the MMC group.

Conclusion: Intraoperative MMC application seems to be a safe adjuvant that could reduce the closure rate of the osteotomy site 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.

KEYWORDS::

• Nasolacrimal duct obstruction
• External dacryocystorhinostomy
• Mitomycin C
• Meta-analysis

ACKNOWLEDGMENTS

Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding Source: This study was supported by the Financing Project of Science and Technology Innovation Plan for College Students of Zhejiang Province, China (2011R413047).