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Karim Bakri, MBBS; Nick S. Jones, MD, FRCS; Richard Downes, FRCS; S. Ahmed Sadiq, FRCS

Arch Otolaryngol Head Neck Surg. 2003;129:233-235.

Background  Although endonasal laser dacryocystorhinostomy (ELDCR) offers many advantages compared with conventional techniques, postoperative scarring leading to occlusion of the rhinostomy is more common with ELDCR.

Objective  To investigate whether fluorouracil applied to the rhinostomy site intraoperatively has an effect on the outcome.

Participants  We randomly allocated 155 consecutive patients (201 procedures) to a control group and a fluorouracil group. Patients and investigators were masked to the choice of treatment.

Methods  All patients underwent ELDCR. A pledget soaked in isotonic sodium chloride solution or 0.5-mg/mL fluorouracil, randomly allocated by the pharmacy, was applied to the rhinostomy site for 5 minutes at the time of surgery. Patients were followed up for 12 months and their symptoms were assessed at each visit.

Results  Among patients followed up for 12 months or longer, ELDCR procedures performed with topical application of fluorouracil to the rhinostomy site were successful in 65 (76%), compared with 52 (63%) for the control group. This was not statistically significant when patients who failed to attend follow-up at or after 12 months were not counted as successfully treated (P = .21, ² test). Even if those who failed to attend for follow-up were counted as successes, the effect of fluorouracil did not reach significance at the .05 level (P = .08, ² test).

Conclusion  The topical application of fluorouracil failed to increase the patency rates in ELDCR.

From the Departments of Otorhinolaryngology (Drs Bakri and Jones) and Ophthalmology (Messrs Downes and Sadiq), University Hospital, Nottingham, England.

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