The effect of Seprafilm on adhesions in strabismus surgery-an experimental study

Seprafilm (Genzyme, Cambridge, MA) is a bioabsorbable membrane composed of sodium hyaluronate and carboxymethylcellulose. Adhesions occurring after strabismus surgery may affect surgical outcome. The purpose of our study was to histopathologically evaluate the influence of Seprafilm on postoperative adhesions.

Seven adult male New Zealand albino rabbits were used. The superior rectus muscle was resected 3 mm, and a fornix-based limbal conjunctival dissection was made inferonasally in both eyes. In one eye of each rabbit, Seprafilm was inserted between the conjunctiva and superior rectus and under the dissected inferonasal conjunctiva. The fellow eye of each rabbit, having undergone superior rectus resection and inferonasal conjunctival dissection without Seprafilm, served as the control group. The rabbits were killed and the eyes were enucleated at 6 weeks after surgery. Histopathological sections were analyzed for inflammation and fibrosis by staining them with hematoxylin-eosin and Masson trichrome, respectively. Inflammation and fibrosis were graded on a scale of 0 to 4.

Compared with the control eyes, there was no significant difference with regard to inflammation either at the area of superior rectus resection or the area of conjunctival dissection (P.655 and P.157, respectively). Significantly less fibrosis occurred in the surgical areas where Seprafilm was used compared with the control group (P.046 and P.015, respectively) both at the area of superior rectus resection and the area of conjunctival dissection.

This study shows that Seprafilm significantly decreases postoperative adhesions between the conjunctiva, muscle, and sclera. Application of Seprafilm may prove useful in strabismus surgery especially where adhesion formation may influence the outcome and in cases where recurrent conjunctival dissection may be needed.