Ali Mohammad Javed, Baig Farhana, Lakshman Mekala, Naik Milind N
*Dacryology Service, L.V. Prasad Eye Institute; †Department of Pathology, Global Hospital; and ‡Ruska Laboratories, College of Veterinary Sciences, Hyderabad, India.
Ophthalmic Plast Reconstr Surg. 2015 Mar-Apr;31(2):103-7. doi: 10.1097/IOP.0000000000000205.
To evaluate the ultrastructural effects of topical and circumostial injection of mitomycin C (COS-MMC) on nasal mucosa and compare them with the controls. The study also aimed at classifying the subcellular effects in detail.
The nasal mucosa of 6 patients were subjected to 0.02% of mitomycin C for 3 minutes (3 patients) and 0.02% COS-MMC (3 patients) as per standard protocol, during endoscopic dacryocystorhinostomy. Normal nasal mucosa from untreated areas (2 each from topical and COS-MMC groups) were taken as controls after harvesting the treated areas. Full thickness tissues (5 mm × 5 mm) were collected for transmission electron microscopy, and ultrastructural effects were evaluated.
Both topical and COS-MMC showed significant and distinct ultrastructural changes involving the epithelial, glandular, vascular, and fibrocollagenous tissues compared with the controls. There were profound changes within fibroblasts with intracellular edema, pleomorphic and vesicular mitochondria, dilated smooth and rough endoplasmic reticulum, and chromatin condensation. In addition, COS-MMC samples showed subepithelial hypocellularity with limited disorganization of structure. The changes in both the MMC groups were restricted to treated areas only.
Both topical and COS-MMC show profound changes in nasal mucosa with more marked changes in COS-MMC group. These changes being limited in nature may help in enhancing the success of dacryocystorhinostomy by preventing cicatricial changes of the ostium, especially in high-risk cases such as revision and post-traumatic dacryocystorhinostomy.
评估局部及围术期注射丝裂霉素C（围术期丝裂霉素C，COS-MMC）对鼻黏膜的超微结构影响，并与对照组进行比较。本研究还旨在详细分类亚细胞效应。
6例患者在鼻内镜下泪囊鼻腔造口术期间，按照标准方案，3例患者使用0.02%丝裂霉素C处理3分钟，3例患者使用0.02% COS-MMC处理。在获取处理区域后，取自未处理区域的正常鼻黏膜（局部用药组和COS-MMC组各2例）作为对照。收集全层组织（5 mm×5 mm）用于透射电子显微镜检查，并评估超微结构效应。
与对照组相比，局部用药组和COS-MMC组均显示出涉及上皮、腺体、血管和纤维胶原组织的显著且明显的超微结构变化。成纤维细胞内有深刻变化，包括细胞内水肿、多形性和泡状线粒体、扩张的滑面和粗面内质网以及染色质凝聚。此外，COS-MMC样本显示上皮下细胞减少，结构紊乱有限。两个丝裂霉素C组的变化仅局限于处理区域。
局部用药组和COS-MMC组均显示鼻黏膜有深刻变化，COS-MMC组变化更明显。这些本质上有限的变化可能有助于提高泪囊鼻腔造口术的成功率，通过防止造口的瘢痕形成变化，特别是在诸如翻修和创伤后泪囊鼻腔造口术等高风险病例中。
