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Category: Volume 07 Issue 07 July 2019
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Title: Flapless modified Toti’s procedure with use of circumosteal Mitomycin C as an adjunctive therapy in management of failed Dacryocystorhinostomy (DCR)

Authors: Dr Nilesh Mohan MD (AIIMS), DNB, ICO (Basic Ophtha), Dr Gyan Bhaskar MS, Dr Bibhuti P Sinha MS, Dr Ankita Kumari MS

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.169

Abstract

Aim: A Prospective study of patients to assess the success rate of repeat DCR surgery by flapless modified Toti’s rhinostomy with intraoperative use of Mitomycin C and syringing with 1 ml of 0.2mg/ml Mitomycin C on first postoperative day in newly formed passage for the treatment of failed DCR.

Methods: 60 consecutive patients (35 females and 25) males qualifying the inclusion criteria for repeat DCR,  were included in our study along with a patent upper, lower and common canaliculus. Patients less than 16 years & more than 70 years with acute attack of dacryocystitis, history of nasal or orbital trauma, secondary NLD obstruction, punctal occlusion, canaliculus obstruction and any nasal pathology causing epiphora were excluded. Surgery was performed under local anaesthesia by a single surgeon. Arruga bone trephine of 10 mm was used in all cases to make an osteum. A circumosteal intra mucosal injection of 0.02% MMC at 4 points (0.1 ml at each point) was given equally at 4 points along the edges of the ostium and 1 point in the anterior remnant of the sac. Syringing with 1 ml of 0.2mg/ml MMC was performed in newly formed passage near the bone osteum on the first postoperative day sac in all cases.

Results: The mean age of the patient was 52.45 +- 15.5 ranging from 16 to 68years comprising 35 females and 25 males. Most common presentation was a mucopurulent discharge and primary acquired nasolacrimal duct obstruction was the was the most common indication of surgery. 57 out of 60 patients were symptom free and patent on syringing at the end of follow up period of one year. No wound infection, abnormal nasal bleeding or any noticeable conjunctival and corneal complications were observed during intraoperative, postoperative or during follow up period and 3 patients had failed syringing at the end of one year possibly due to circumosteal fibrous tissue.

Conclusion: Results suggests that our modified technique had safety, reliability, high success rate and can be easily done by most surgeons.

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Corresponding Author

Dr Bibhuti P Sinha MS

Professor & HOD, RIO, IGIMS, Sheikhpura, Patna, India