Abstract:
Purpose: To evaluate the effectiveness of bacterial cellulose membrane (BCM) in preventing fibrosis in trabeculectomy and the biocompatibility of BCM with conjunctiva and sclera. Methods: Twenty-one eyes of 21 adult rabbits underwent fornix-based trabeculectomy. Standard surgery was done to control group (CG, n=7). Mitomycin-C (0.3▒mg/mL, 3▒min) was applied to MMC group only (MMCG, n=7). BCM (100▒µm thick,10×10▒mm,single layer) was covered on the sclerotomy area before conjunctiva was closed in BCM group (BCMG, n=7). Intraocular pressures (IOP) were measured before, and 7, 14, 28 and 45 days after surgery (IOP-POD7,POD14,POD28,POD45). The IOP decrease were expressed as DIOP%-POD7, DIOP%-POD14,DIOP%-POD28 and DIOP%-POD45. The rabbits were sacrificed on the 45th day. Conjunctival vessel (CV) number, degrees of fibrosis, total inflammation, foreign body reaction (FBR), inflammatory cell types (B-cells,T-cells,plasma cells, macrophages, bleb spaces and the expression of α-smooth muscle actin(α-SMA) were studied using histopathology and immunohistochemistry techniques. The groups were compared using nonparametric tests. Results: There was no statistically significant difference between the groups regarding baseline IOP and DIOP%-POD7 (P>0.05). While DIOP%-POD14, 28 and 45 were similar between BCMG and MMCG, they were significantly lower in CG (P<0.05). The lowest CV number was detected in the MMCG but the difference was not significant. There was no difference between BCMG and CG with regard to the numbers of B-cells, T-cells and macrophages, however these cells were significantly lower in MMCG (P<0.05). Five cases had mild and 2 cases had moderate FBR in the BCMG. There was mild to moderate inflammation in all BCM cases. While fibrosis and α-SMA staining were higher in the CG (P<0.001), they were minimal in the BCM and MMC groups. Conclusions: BCM showed good biocompatibility and provided better control of IOP with minimal fibrosis in trabeculectomy site compared to the control group. © 2021 American Medical Association. All rights reserved.