[Mitomycin C after endoscopic endonasal dacryocystorhinostomy]

[Pharmacological prevention of fibrosis in dacryosurgery]

Chronic inflammatory process in the lacrimal drainage system is the main etiological factor leading to dacryostenosis and consequent obliteration - partial and total nasolacrimal duct obstruction. Prevention of this process is an urgent problem in dacryology. Currently, there is very little research on the development and use of conservative methods for treating dacryostenosis using anti-inflammatory, as well as anti-fibrotic drugs. In this regard, the main method of treating lacrimal drainage obstruction is dacryocystorhinostomy. However, the problem of recurrence after this operation has not been resolved. The causes of recurrence can be cicatricial healing of dacryocystorhinostomy ostium, canalicular obstruction, formation of granulations and synechiae in its area. Surgical methods of recurrence prevention are associated with possible complications, and there is conflicting data on the feasibility of their use. Based on this, the development of pharmacological methods for the prevention of fibrosis in dacryology is promising, among which the antitumor antibiotic Mitomycin C is the most studied. However, there are no specific scientifically substantiated recommendations for the use of this drug, and the data on its effectiveness vary. This has prompted researchers to look for and study alternative anti-fibrotic agents, such as antitumor drugs, glucocorticoids, hyaluronic acid, small molecule, biological, immunological and genetically engineered drugs, as well as nanoparticles. This review presents the current data on the efficacy and prospects of the use of these drugs in dacryology.

Morphological features of regenerative processes after dacryocystorinostomy with the use of mitomycin C

PURPOSE

To study the morphological features of regenerative processes in dynamics after dacryocystorinostomy (DCR) with the use of Mitomycin C (MMC).

METHODS

The study includes 31 cases. All patients underwent endonasal endoscopic DCR. Group 1 included 16 cases who received MMC injections. Group 2 included 15 cases who were treated with MMC on collagen sponge into the area of formed anastomosis. Biopsies for histological examination were taken on the 2nd, 5th, 7th, 14th, 21st, 28th and 60th days after the surgery. The samples were subjected to histological examination.

RESULTS

Activated fibroblasts were detected in patients of group 2 on the 5th day after the surgery which became the main cellular elements by the 14th day, and incomplete fibroblast mitoses were observed in group 1 by the 14th day. On the 28th day after the surgery, the transformation of the extracellular matrix into loose connective tissue was determined in patients of group 2, while single cellular elements represented by fibroblasts were preserved in biopsies obtained from patients of group 1. By the 60th day after the surgery, the restoration of a full-fledged epithelial lining was observed in all specimens.

CONCLUSION

With the injection of MMC, inhibition of collagenogenesis by depression of extracellular collagen matrix formation, production of abortive mitoses in cells and inhibition of maturation and transformation of fibroblasts occur. The regeneration process takes place after MMC injection under a relative decrease in fibroblast impact.

[Modern methods in treatment of lacrimal system vertical part obliteration]

A review of the literature is devoted to the description of modern methods in treatment of lacrimal system vertical part obliteration. Particular attention is paid to various aspects of the most common surgical intervention - endonasal endoscopic dacryocystorhinostomy.

[Intraoperative prevention of dacryocystitis relapse]

The article reviews the literature devoted to modern intraoperative methods of preventing cicatricial process at the site of dacryostoma after endonasal endoscopic dacryocystorhinostomy. Despite the constant improvement of the surgery technique, complications in the postoperative period still occur. They include the formation of granulation tissue at the sites of dacryostoma, synechiae in the nasal cavity, or narrowing of the dacryostoma, which ultimately leads to a relapse of the disease. The main prevention methods are construction of flaps from the medial wall of the lacrimal sac, from mucosa of the nasal cavity, and intubation of the dacryostoma with the lacrimal implant. They are used separately and in various combinations.