Abstract
Purpose :
To evaluate the effectiveness of bacterial cellulose membrane (BCM) in preventing fibrosis in a rabbit model trabeculectomy surgery and to investigate the biocompatibility of BCM with eye tissues.
Methods :
Twenty-one eyes of 21 adult male rabbits underwent fornix-based trabeculectomy. Standard surgery was applied to the control group (CG, n=7). In addition to the standard process; mitomycin-C (MMC, 0.3 mg/ml) was applied to the sclerotomy area for 3 minutes to MMC group (MMCG, n=7), and in the BCM group (BCMG, n=7), the sclerotomy area was covered with BCM (10x10 mm, ~ 100 µm thick) as a single layer before closing the conjunctiva. BCM was sutured to the sclera from the proximal edges, and the distal edge was extended to the fornix freely. Intraocular pressures (IOP) were measured before surgery (baseline) and on the postoperative 7th, 14th, 28th and 45th days (IOP-POD7, POD14, POD28 and POD45). The rate of decrease in IOP over time were calculated according to the baseline values and expressed as decrease in IOP% (DIOP%)-POD7, DIOP%-POD14, DIOP%-POD28 and DIOP%-POD45. The rabbits were sacrificed on the 45th day. The surgery area was examined histopathologically and immunohistochemically for conjunctival vascularity, fibrosis, inflammation, foreign body reaction and expression of α-smooth muscle actin (α-SMA).
Results :
There was no difference between the three groups in terms of baseline IOP and DIOP%-POD7 (p=0.126, p=0.620, respectively). While DIOP%-POD14, 28 and 45 values were similar between BCM and MMC groups, they were significantly lower in the CG compared to the others (p <0.05). The groups were similar with regard to conjunctival vascularity (p = 0.122). Only in the BCMG group, 2 cases had moderate and 5 cases had mild foreign body reaction. There was no difference between CG and MMCG regarding inflammation, but moderate reaction was detected in all cases in the BCMG (p=0.01). While fibrosis and α-SMA levels were found to be significantly higher in the CG (p<0.001), there was no difference between the MMCG and BCMG.
Conclusions :
Bacterial cellulose membrane provided better control of IOP with minimal fibrosis compared to the control. It was also found to have a good biocompatibility with eye tissues. With these features, BCM may be a candidate for use as an adjuvant tissue not only in trabeculectomy but also in other ocular surgeries.
This is a 2021 ARVO Annual Meeting abstract.