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Abstract
BackgroundPostoperative adhesion is one of the major complications of strabismus surgery and result in motility dysfunction that brings unpredictable surgical outcomes. However, there was no definitely accepted treatment method to prevent postoperative adhesion.MethodsA prospective, randomized, controlled experimental animal study was performed. Both eyes of each of 14 New Zealand White rabbits underwent superior rectus muscle recession. After the surgical procedure, the subjects were divided randomly into two groups; 0.5 % tranilast ophthalmic solutions and fluoroquinolone antibiotic eye drops were administered to the group tranilast (N = 14), while the group control (N = 14) received fluoroquinolone eye drops only. Five weeks after surgery, we evaluated gross adhesions with a numeric score (0 to 4). In addition, histopathologic examination with hematoxylin & eosin staining, Masson’s-trichrome staining, and anti-transforming growth factor beta 1 (TGF-β1) immuno-histochemical staining were done.ResultsThe group tranilast showed significantly less gross adhesion and inflammation than the group control (P = 0.01 and P < 0.001, respectively). Masson’s-trichrome staining revealed that post-operative collagen deposition was more prominent in the group control than the group tranilast (P < 0.001). Moreover, remarkable TGF-β1 expression was observed in areas with excessive collagen deposition.ConclusionsInstillation of 0.5 % tranilast ophthalmic solution is a simple and effective method for preventing post-operative adhesion after strabismus surgery.
Highlights
Postoperative adhesion is one of the major complications of strabismus surgery and result in motility dysfunction that brings unpredictable surgical outcomes
The eyes in group control (14/28 eyes) revealed adhesion ranging from mild-to-moderate and moderateto-dense to non-dissectible
There was less post-operative recession site adhesion in group tranilast compared to group control (P = 0.01, Fisher’s exact test)
Summary
Postoperative adhesion is one of the major complications of strabismus surgery and result in motility dysfunction that brings unpredictable surgical outcomes. Various surgical and medical approaches have been used to reduce postoperative inflammation and adhesion after strabismus surgery. These include antimetabolites (5-fluorouracil, mitomycin C), mechanical barriers (silicone sleeve, polyglactin 910 mesh, Seprafilm [Genzyme, Cambridge, MA, USA]), anti-inflammatory agents (triamcinolone), and lubricants (sodium hyaluronate) [1, 2, 5,6,7,8,9,10]. Tranilast is a derivative of the amino acid tryptophan and was developed as an anti-allergy drug [11, 12] It prevents inflammation and collagen synthesis derived from keloid and hypertrophic scarring [11].
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