Journal List > J Korean Ophthalmol Soc > v.50(1) > 1008380

Kwon, Seo, and Cho: Antiadhesive Effect of the Mixed Solution of Hyaluronate and Sodium Carboxymethylcellulose After Strabismus Surgery

Abstract

Purpose

To evaluate the effect of the mixed solution of hyaluronate and sodium carboxymethylcellulose (HACMC, Guardix-sol®) in reducing postoperative adhesion following strabismus surgery.

Methods

In 16 rabbits out of 20 rabbits, 3 mm recession of the superior rectus muscle was performed on both eyes and HACMC solution was applied only to one eye which was randomly chosen. The rabbits were divided into a surgery-HACMC group and a surgery-no HACMC group. As a control group, the remaining 4 rabbits had no procedures performed. After 3 weeks, both eyes of 8 rabbits with surgery and 2 rabbits of the control group were enucleated. After staining with hematoxylin-eosin and Masson's trichrome, a histologic examination was performed. In the remaining 10 rabbits, the severity of adhesion in muscle and adjacent tissues was observed by blunt dissection. A researcher blind to the experiments performed all the examinations.

Results

A significant reduction in the degree of adhesion (P=0.005) as well as decreased fibrosis (P=0.015) was observed in the surgery-HACMC group.

Conclusions

The mixed solution of HACMC was effective in reducing postoperative adhesion after strabismus surgery in rabbits.

References

1. Metz HS. Restrictive factors in strabismus. Surv Ophthalmol. 1983; 28:71–83.
crossref
2. Dunlap EA. Surgery of muscle adhesions and effects of multiple operations. Br J Ophthalmol. 1974; 58:307–12.
crossref
3. Parks MM. Causes of the adhesive syndrome. Trans New Orleans Academy of Ophthalmology. Symposium on Strabismus. St. Louis: CV Mosby;1978. chap. 18.
4. Gomel V, Urman B, Gurgan T. Pathophysiology of adhesion formation and strategies for prevention. J Reprod Med. 1996; 41:35–41.
5. Shokida MF. Use of silicone sheet for delayed adjustable strabismus surgery. Ophthalmic Surg. 1993; 24:486–8.
6. Nemet P, Stolovitch C. Delayed reattachment of extraocular muscle. Binocul Vis. 1989; 4:23–6.
7. Hwang JM, Chang BL. Use of Viscoat for delayed post-operative adjustable suture strabismus surgery in rabbits. Binocul Vis Strabismus Q. 1996; 11:137–42.
8. Hwang JM, Chang BL. Use of physical barriers for delayed adjustable strabismus surgery; the effect of Interceed and polyglactin 910 mesh. Br J Ophthalmol. 1996; 80:759–762.
crossref
9. Cho YA, Shon TS, Lee DS. The effects of subconjunctival betamethasone, 5-fluorouracil and mitomycin C on postope- rative adhesion after strabismus surgery. J Korean Ophthalmol Soc. 1994; 35:1698–709.
10. Hwang JM, Chang BL. Combined effect of Interceed and 5-fluorouracil on delayed adjustable strabismus surgery. Br J Ophthalmol. 1999; 83:788–91.
crossref
11. Hwang JM, Chang BL. Combined effect of polytetrafluoro- ethylene and 5-fluorouracil on delayed adjustable strabismus surgery. J Pediatr Ophthalmol Strabismus. 2000; 37:163–7.
12. Oh SO, Chang BL, Lee J. Effect of mitomycin C on delayed adjustment in experimental strabismus surgery. Korean J Ophthalmol. 1995; 9:51–8.
13. Özkan SB, Kir E, Culhaci N, Dayanir V. The effect of Seprafilm on adhesions in strabismus surgery-an experimental study. J AAPOS. 2004; 8:46–9.
crossref
14. Searl SS, Metz HS, Lindahl KJ. The use of sodium hyaluronate as a biologic sleeve in strabismus surgery. Ann Ophthalmol. 1987; 19:259–68.
15. Brown DR, Pacheco EM, Repka MX. Recovery of extraocular muscle function after adjustable suture strabismus surgery under local anesthesia. J Pediatr Ophthalmol Strabismus. 1992; 29:16–20.
crossref
16. Oh SO, Lee JH. Reduction of postoperative adhesion in strabismus surgery. Koran J Ophthalmol. 1992; 6:76–82.
17. Cruz OA. Evaluation of mitomycin to limit postoperative adhesions in strabismus surgery. J Pediatr Opthalmol Stra-bismus. 1996; 33:89–92.
crossref
18. An GJ, Cho YA. The effects of single intraoperative application of mytomycin C soaked cottonoid on the wound healing. J Korean Ophthalmol Soc. 1995; 36:2252–60.
19. Hwang JM. Use of polytetrafluoroethylenefor delayed adjustable strabismus surgery in human 2. J Korean Ophthal-mol Soc. 1999; 40:829–32.
20. Yaacobi Y, Hamed LM, Kaul KS, Fanous MM. Reduction of postoperative adhesions secondary to strabismus surgery in rabbits. Ophthalmic Surg. 1992; 23:123–8.
crossref
22. Silver FH, LiBrizzi J, Benedetto D. Use of viscoelastic solutions in ophthalmology: a review of physical properties and long-term effects. J Long Term Eff Med Implants. 1992; 2:49–66.
23. Goa KL, Benfield P. Hyaluronic acid. A review of its pharmacology and use as a surgical aid in ophthalmology, and its therapeutic potential in joint disease and wound healing. Drugs. 1994; 47:536–66.
24. Kim JH, Lee JH, Yoon JH. . Antiadhesive effect of the mixed solution of sodium hyaluronate and sodium carboxymethylcellulose after endoscopic sinus surgery. Am J Rhynol. 2007; 21:95–9.
crossref
25. Do JW, Lee YW, Park HJ. . The effectiveness of hyaluronic acid + sodium carboxymethyl cellulose in the prevention of intrauterine adhesion after intrauterine surgery. Korean J Gastrointest Endosc. 2005; 17:112–7.
26. Johns DB, Keyport GM, Hoehler F, diZerega GS. Reduction of postsurgical adhesions with Intergel adhesion prevention solution: A multicenter study of safety and efficacy after conservative gynecologic surgery. Fertil Steril. 2001; 76:595–604.
27. Andreo LK, Uyemura MJ, Enzenauer RW. 5-Fluorouracil reduces scarring after strabismus surgery. J Pediatr Ophthal-mol Strabismus. 1997; 34:107–10.
crossref

Figure 1.
Light microscopic findings at 3 weeks after surgery (Hematoxylin-eosin stain, ×400). (A, B): Control group; (C, D): Surgery-no HACMC group; (E, F): Surgery-HACMC. The surgery-HACMC group (E, F) was less inflamed than the surgery-no HACMC (C, D) but there was no significant difference between two groups.
jkos-50-145f1.tif
Figure 2.
Light microscopic findings at 3 weeks after surgery (Masson’s trichrome stain, ×400). (A, B): Control group; (C, D): Surgery-no HACMC group; (E, F): Surgery-HACMC group; The Surgery-HACMC group (E, F) revealed some decrease of fibrosis compared to the without coating group (C, D).
jkos-50-145f2.tif
Table 1.
The severity of postoperative adhesion in 3 groups (Mean± SD)
Surgery-no HACMC group Surgery-HACMC group Control (nonsurgery) group
C-M 2.63±0.74 1.50±0.53 0.33±0.55
M-S 0.38±0.52 0.13±0.35 0.00±0.00

HACMC=the mixed solution of hyaluronate and sodium carboxymethylcellulose (Guardix-sol®)

C-M=distance between conjunctiva and muscle

M-S=distance between muscle and sclera.

Table 2.
Comparison of inflammatory cell count in 2 groups (P=0.279)
No. of eye n Surgery-no HACMC group Surgery-HACMC group
1 35 38
2 38 33
3 37 32
4 31 34
5 30 33
6 41 37
7 38 36
8 39 33
Average 36.13 34.50

HACMC=the mixed solution of hyaluronate and sodium carboxymethylcellulose (Guardix-sol®).

Table 3.
The severity of postoperative fibrosis in 2 groups (P=0.015)
Grade of fibrosis (Mean± SD)
Surgery-no HACMC group 3.00±0.76
Surgery-HACMC group 1.87±0.64

HACMC=the mixed solution of hyaluronate and sodium carboxymethylcellulose (Guardix-sol®).

TOOLS
Similar articles