Efficacy of mitomycin-C and infliximab in reducing adhesionand fibrosis following strabismus surgery*

Abstract

IntroductionAdhesion, fibrosis, and scarring formation following strabismus surgery are among the most important problems that unfavorably influence surgical success. The exact incidence of scars, adhesion, and fibrosis has not been reported but Ludwig retrospectively reviewed 134 reoperations in which a stretched scar was discovered and estimated that stretched scar tissue was a contributing factor in 10% of all strabismus reoperations and 50% of late overcorrections (1). Adhesion is the attachment that occurs in some tissues including the conjunctiva, Tenon's capsule, the intermuscular membrane, orbital adipose tissue, the sclera, and extraocular muscular tissue due to any reason during or after strabismus surgery. These adhesions may result from inappropriate surgical approach, excessive bleeding, cautery usage, suture reaction, postoperative infection, muscular capsule injury, migration of adipose tissue to the surgical area due to the laceration of the orbital septum, and multiple procedures performed in the same region (2). Fibrosis is the contracture occurring after inflammation of extraocular muscles. Appropriate surgical techniques should be performed to avoid postoperative adhesion and fibrosis and subsequent scarring (2,3).Adhesion, fibrosis, and scar formation after strabismus surgery bring along unfavorable consequences for both the patient and the surgeon. Need for a second surgery not only psychologically influences the patient negatively but also leads to further tissue injury during the second intervention and causes additional expense. Reducing adhesion, fibrosis, and scarring after strabismus surgery would provide results that are more satisfactory for both patients and surgeons by enhancing anatomical success. For this purpose, many materials and drugs have been studied in experimental or clinical trials; nevertheless, no Background/aim: The present study aimed to investigate the efficacy of mitomycin-C (MMC) and infliximab (INF) in reducing adhesion and fibrosis following strabismus surgery. Materials and methods:Forty eyes of 20 albino rabbits were separated into MMC and INF groups. Right and left eyes of rabbits were assigned to the drug and control groups, respectively. The superior rectus muscle was disinserted, the drug was administered to the surgical area for 5 min in the drug eyes (MMC 0.2 mg/mL or INF 5 mg/mL), and physiological saline was administered to the control eyes. Surgical areas were rinsed with 10 mL of physiological saline. The disinserted muscle was then sutured to the same area using 6.0 Vicryl. The rabbits were sacrificed after 4 weeks for histopathological examination.Results: Significant reduction was observed in fibrosis in the INF group as compared to the control group (P = 0.005). Although adhesion formation in the drug eyes reduced in the MMC and INF groups as compared to the control group, the difference was not significant (P = 0.280 and P = 0.579, respectively). Conclusion:This study demonstrated the fibrosis-preventing efficacy of IFN; thus, it can be a good o...

Effects of the Rho-Kinase Inhibitor Y-27632 on Extraocular Muscle Surgery in Rabbits

“…Numerous studies by strabismologists have been devoted to reducing postoperative adhesions using a variety of materials, including polyglactin 910 mesh [ 1 ], mitomycin C [ 2 , 3 ], and Seprafilm (Genzyme, Cambridge, MA) [ 4 ]. However, these methods have problems with their associated complications, unavailability, or inconsistent results.…”

“…However, these methods have problems with their associated complications, unavailability, or inconsistent results. There is also a debate as to whether mitomycin C reduces inflammatory response after strabismus surgery significantly [ 2 , 3 ].…”