J Korean Ophthalmol Soc.  2009 Jan;50(1):145-150. 10.3341/jkos.2009.50.1.145.

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

• Kwon SW
• Seo YW
• Cho YA

• KMID: 2211910
• DOI: http://doi.org/10.3341/jkos.2009.50.1.145

Abstract

PURPOSE
To evaluate the effect of the mixed solution of hyaluronate and sodium carboxymethylcellulose (HACMC, Guardix-sol(R)) 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.

Keyword

Adehesion; Sodium carboxymethylcellulose; Sodium hyaluronate; Strabismus surgery

MeSH Terms

Carboxymethylcellulose Sodium
Eye
Fibrosis
Hyaluronic Acid
Muscles
Rabbits
Sodium
Strabismus
Carboxymethylcellulose Sodium
Hyaluronic Acid
Sodium

Figure

• 

  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.

• 

  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).

Reference

References

1. Metz HS. Restrictive factors in strabismus. Surv Ophthalmol. 1983; 28:71–83.

2. Dunlap EA. Surgery of muscle adhesions and effects of multiple operations. Br J Ophthalmol. 1974; 58:307–12.

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.

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.

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.

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.

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.

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.

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.

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.