Turkiye Klinikleri Journal of Ophthalmology

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Eksternal Dakriyosistorinostomide Mitomisin C Kullanımının Klinik, Radyolojik ve Endoskopik Etkilerinin Değerlendirilmesi
Evaluation of the Clinical, Radiologic and Endoscopic Effects of Intraoperative Mitomycin C Application in External Dacryocystorhinostomy
Seray ASLAN BAYHANa, Ömer Faruk RECEPb, Hasan Ali BAYHANa, İbrahim ÖZCANc, Lale PAŞAOĞLUd, Hikmet HASIRİPİb
aGöz Hastalıkları AD, Bozok Üniversitesi Tıp Fakültesi, Yozgat
bGöz Hastalıkları Kliniği,
cKBB Kliniği,
dRadyoloji Kliniği, Ankara Numune Eğitim ve Araştırma Hastanesi, Ankara
Turkiye Klinikleri J Ophthalmol. 2013;22(2):87-95
Article Language: TR
Full Text
ÖZET
Amaç: Eksternal dakriyosistorinostomi (DSR) cerrahisinde mitomisin C (MMC) kullanımının klinik, radyolojik ve endoskopik etkilerini değerlendirmek ve konvansiyonel DSR ile karşılaştırmak. Gereç ve Yöntemler: Bu çalışmada, DSR operasyonu uygulanan 35 olgunun 37 gözü değerlendirildi. DSR sırasında 19 gözde kemik açıklığa ve fleplere 0,4 mg/mL MMC 5 dakika uygulandı. On sekiz göz ise kontrol grubu olup konvansiyonel DSR yapıldı. Nazal mukozal açıklık cerrahi sonrası 10. gün, 3. ve 6. aylarda endoskopik olarak değerlendirildi, ameliyat sonrası 10. gün ve 6. ayda bilgisayarlı tomografi ile kemik açıklık değerlendirildi. DSR cerrahisi sonuçları objektif olarak lavajla ve subjektif olarak epifora varlığı sorgulanarak değerlendirildi. Bulgular: Cerrahi başarı MMC uygulanan grupta %94,8, kontrol grubunda %88,9 idi ve gruplar arasında başarı açısından fark yoktu (p>0,05). Nazal mukozal açıklık alanında MMC grubunda 6. ayda 10. güne göre ortalama %49,4 azalma izlenirken, kontrol grubunda ortalama %78,7 azalma mevcuttu (p=0,04). MMC uygulanan grupta kemik açıklık boyutunda 6. ayda 10. güne göre ortalama küçülme oranı %18,7 iken, kontrol grubundaki küçülme oranı ortalama %13,2 idi. Kemik penceredeki küçülme oranı gruplar arası istatistiksel olarak farklı değildi (p>0,05). MMC grubundaki hastalarda sonuç nazal mukozal açıklık boyutunun kontrol grubuna göre daha büyük olduğu ancak MMC'nin kemik açıklık üzerine etkisi olmadığı görüldü. Ameliyat sırasında MMC kullanımı olguların ameliyat sonrası dönemdeki semptomlarında herhangi bir farklılık oluşturmadı. Sonuç: DSR cerrahisinde MMC kullanımı daha büyük nazal mukozal açıklık sağlamaktadır, ancak ameliyat sonrası dönemde hasta şikâyetlerinin azaltılmasında etkinliği yoktur.

Anahtar Kelimeler: Mitomisin; dakriyosistorinostomi
ABSTRACT
Objective: To evaluate the clinical, radiologic and endoscopic effects of intraoperative mitomycin C (MMC) application in external dacryocystorhinostomy (DCR) surgery and to compare with results of the conventional procedure. Material and Methods: This study is comprised of 37 eyes of 35 patients. During DCR surgery of 19 eyes 0.4 mg/mL MMC was applied to the flaps and osteotomy site for 5 minutes. 18 eyes were taken as control group and conventional DCR was performed in their surgeries. Nasal endoscopic evaluation was performed on the tenth postoperative day, at 3 months and at 6 months after surgery. Osteotomy was evaluated with computerized tomography on the tenth postoperative day and at 6 months after surgery. The results of the DCR surgeries were evaluated by irrigation objectively and subjective symptoms by asking patients the condition of tearing. Results: Surgical success was 94.8% in MMC C group and 88.9% in control group; the difference between the groups was not significant (p>0.05). Reduction in nasal mucosal ostium size -between the tenth day and 6 months after surgery- was 49.4% in the MMC group and 78.7% in the control group (p=0.04). At sixth months after surgery reduction in bony ostium was 18.7 % in the MMC group and 13.2% in the control group. The difference between the groups was not significant (p>0.05). Final intranasal mucosal ostium size in MMC group was greater than the final intranasal ostium of the control group but MMC had no effect on the bony ostium size. Application of MMC did not cause a difference in patient symptomatology. Conclusion: Intraoperative MMC application in DCR surgery maintains greater nasal ostium but it is not effective for decreasing patient complaints postoperatively.

Keywords: Mitomycin; dacryocystorhinostomy

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