Use of mitomycin c versus gentamicin and dexamethasone in endonasal endoscopic dacrocystorhinostomy

Aniket R. Buche, Sachin H. Garud, Surendra H. Gawarle, Gaurav A. Chamania


Background: Dacrocystorhinostomy (DCR) is the procedure done to drain the lacrimal sac in cases of nasolacrimal duct obstruction or in chronic dacrocystitis. New advancements in nasal endoscopic surgeries have given results comparable to external DCR. This is a prospective, case control, randomized, double blinded study to compare efficacy of mitomycin c local application versus gentamicin + dexamethasone local application intraoperatively.

Methods: Fifty two patients who underwent endonasal endoscopic DCR at our Tertiary care centre between October 2015 and February 2017. All patients were operated by a single surgeon with double blind method of assigning case. In 26 patients pledgets soaked with 0.4 mg/ml mitomycin C were kept over operative site for 10 min and in other 26 patients pledgets soaked with gentamicin and dexamethasone. Post operatively patients were assessed after 1st and 2nd week and 1st and 3rd month after surgery; post-operative complaints of epiphora were graded.  

Results: Maximum patients belonged to the age group of 31-60 yrs (78%), females constituted the majority with n=36 (69%). At the end of the study Group A had 92% success and Group B had 85% relief in complaints.

Conclusions: We have found statistically insignificant difference between the outcome of local application of Mitomycin C and Gentamicin and dexamethasone. Thus it can be used as substitute or adjuvant with mitomycin C in the intraoperative procedure.


DCR, Mitomycin C, Gentamicin, Dexamethasone

Full Text:



Becker BB. Dacryocystorhinostomy without flaps. Ophthalmic surgery. 1988;19(6):419-27.

Dubey SP, Munjal VR. Endoscopic DCR: How To Improve The Results. Indian J Otolaryngol Head Neck Surg. 2014;66(2):178-81.

Cheng SM, Feng YF, Xu L, Li Y, Huang JH. Efficacy of Mitomycin C in Endoscopic Dacryocystorhinostomy: A Systematic Review and Meta-Analysis. PLOS ONE. 2013;8(5):e62737.

Kurasirikul S, Vichyanond P, Piboonpocanun O, Praikanahok J, Visitsunthorn N. Efficacy Of Gentamicin Nasal Irrigation In Chronic Rhinosinusitis In Children. J Allerg Clin Immunol. 2012;129(2):44.

Jacobs HB. Symptomatic Epiphora. Br J Ophthalmol. 1959;43(7):415-34.

Hartikainen J, Antila J, Varpula M, Puukka P, Seppa H, Grenman R. Prospective randomized comparison of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy. Laryngoscope. 1998;108(12):1861-6.

Maquet JA, Dios E, Aragon J, Bailez C, Ussa F, Laguna N. Protocol for mitomycin C use in glaucoma surgery. Acta ophthalmologica Scandinavica. 2005;83(2):196-200.

Nair A, Ali M. Mitomycin-C in dacryocystor-hinostomy: From experimentation to implementation and the road ahead: A review. Indian J Ophthalmol. 2015;63(4):335-9.

Zeng M, Li Z-Y, Ma J, Cao PP, Wang H, Cui YH, et al. Clarithromycin and dexamethasone show similar anti-inflammatory effects on distinct phenotypic chronic rhinosinusitis: an explant model study. BMC Immunol. 2015;16:37.

Mak ST, Io IY, Wong AC. Prognostic factors for outcome of endoscopic dacryocystorhinostomy in patients with primary acquired nasolacrimal duct obstruction. Graefe's archive for clinical and experimental ophthalmology=Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie. 2013;251(5):1361-7.

Selig YK, Biesman BS, Rebeiz EE. Topical Application of Mitomycin-C in Endoscopic Dacryocystorhinostomy. Am J Rhinol. 2000;14(3):205-7.

Dolmetsch AM. Nonlaser endoscopic endonasal dacryocystorhinostomy with adjunctive mitomycin C in nasolacrimal duct obstruction in adults. Ophthalmology. 2010;117(5):1037-40.

Ghosh S, Roychoudhury A, Roychaudhuri BK. Use of mitomycin C in endo-DCR. Indian J Otolaryngol Head Neck Surg. 2006;58(4):368-9.