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

J Korean Ophthalmol Soc 2009;50(1):145-150.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.1.145

Antiadhesive Effect of the Mixed Solution of Hyaluronate and Sodium Carboxymethylcellulose After Strabismus Surgery

Sung Wook Kwon, M.D., Young Woo Seo, M.D., Yoonae A. Cho, M.D.

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Yoonae A. Cho, MD, PhD Department of Ophthalmology, Korea University College of Medicine #5ga Anam-dong, Sungbuk-gu, Seoul 136-705, Korea Tel: 82-2-920-5520, Fax: 82-2-924-6820, E-mail: earth317@yahoo.co.kr

Received 4 November 2008       Accepted 1 August 2008

Copyright © 2009 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Adehesion, Sodium carboxymethylcellulose, Sodium hyaluronate, Strabismus surgery

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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®).

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