Indian Survey on Practice Patterns of Lacrimal and Eyelid Disorders (iSUPPLE) Report 2: Mitomycin-C and Lacrimal Stents in Dacryocystorhinostomy

Purpose:The aim of the study was to assess practice patterns on the use of intraoperative Mitomycin-C (MMC) and lacrimal stents (intubation) in dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction (NLDO) among oculoplastic surgeons in India. The survey was aimed at obtaining data on the duration of stent placement and specifics regarding MMC usage namely, concentration and duration of application.Methods:A survey that included questions on the management of lacrimal disorders was sent in April 2015 to members of the Oculoplastic Association of India, through an email communication. The results were tabulated and analyzed.Results:External DCR is the preferred surgery of choice to treat NLDO for most oculoplastic surgeons (86%) surveyed. A majority (58%) of the respondents do not place stents during DCR routinely in their practice. Lesser experienced oculoplastic surgeons (<10 years of experience) when compared with more experienced surgeons were more likely to place stents routinely in their DCRs (59% versus 19%; P=0.0002). Of the special situations that the respondents would consider stent placement, the most common scenarios were the presence of coexisting canalicular pathology followed by cases of previously failed DCRs. The preferred duration for stent removal was 3 months (48%). Intraoperative MMC was used routinely by only 36% of the respondents. The most common condition where they would consider intraoperative MMC was previously failed DCRs. Three minutes (25%) and 0.2mg/mL (30%) were the preferred duration of application and concentration of MMC, respectively.Conclusions:External DCR is the most preferred surgery for NLDO; in comparison, endoscopic DCR enjoys less popularity as the surgical procedure of choice in NLDO. Adjunctive procedures, namely intraoperative MMC and stenting of the lacrimal passages, are not routinely performed; however, previously failed DCRs are common indications when the respondents may use MMC and/or lacrimal stents. Three months is the preferred duration for stent removal. The trends regarding the concentration of MMC and the application show considerable variation, underscoring the need for evidence-based guidelines to assist oculoplastic surgeons.