Closed Intubation with Mitomycin C Application for Nasolacrimal Duct Obstruction Patients beyond the Age of Two Years

Purpose: to explore safety and efficacy of adding Mitomycin C to intubation in prevention of recurrence and increasing the success rate of closed intubation in patients beyond the age of 2 years. Patients and methods: Prospective study included thirty eyes of 24 consecutive patients with tearing and discharges due to primary and acquired partial NLD obstruction, their ages were from 2.5 to 40 years, Male/Female ratio was 10/14. Probing of NLD with SI (which is soaked in Mitomycin C 0.2 mg/ml for 2 minutes) was done in all cases, but it was abandoned if the resistance or obstruction was too difficult to overcome or if excessive bleeding or a hard blind bony pouch at the end of the nasal lacrimal duct was found (5 patients). In these patients, DCR was performed, and these patients were excluded from our study. Results: The procedure was successful in 24 eyes and unsuccessful in 6 eyes. The mean age of the patients with unsuccessful outcomes was 22.4±3.4 years, whereas that of the patients with successful outcomes was 8.0±2.8 years and the difference was statistically significant (P=0.006). Gender and time at mean silicone tube removal (both P>0.05) were not statistically different. No serious intra- and/or post-operative complications including excessive bleeding, punctal damage, ‘cheese wiring', dacryocystitis, or pyogenic granuloma formation were observed. Conclusion: The results of our prospective study showed that SI with MMC in patients with simple epiphora has a success rate of 80%. This success rate was achieved by other studies using SI alone, but in younger age group. In our study, we include elder patient group with almost the same success rate. So, we can conclude that MMC application during SI does not appear to have additional benefit over SI alone in young children with simple epiphora. While the application of MMC during SI would result in better efficacy compared to SI alone in older ages.