The Effect of Seprafilm on Adhesions in Strabismus Surgery—An Experimental Study Seyhan B. O ¨ zkan, a Erkin Kır, a Nil Culhacı, b and Volkan Dayanır a Purpose: 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. Methods: 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 conjunc- tival 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. Results: 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. Conclusion: 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 conjunc- tival dissection may be needed. (J AAPOS 2004;8:46-49) O neofthemajorproblemsinstrabismussurgeryis thedevelopmentofpostoperativeadhesions,par- ticularlyinpatientswhorequiremultiplesurger- ies.Theadhesionsmayinvolveconjunctiva,Tenon’scap- sule,intermuscularmembrane,orbitalfat,sclera,andex- traocularmuscle.Theformationofscartissuemayaffect thefunctionofextraocularmusclesandresultinmotility problemsthatcouldaltersurgicaloutcome. In an attempt to decrease surgical adhesions, various materials and medicines—such as supramide (Supramide Extra;Jackson,Alexandra,VA),siliconesleeve,polyglactin 910 mesh (Vicryl; Ethicon, Edinburgh, Scotland), polypeptide sleeve, oxidized regenerated cellulose sleeve (Interceed; Johnson & Johnson, Arlington, TX), sodium hyaluronate, mitomycin C, and 5 fluorouracil—are used. 1-11 Noneoftheseproductscarriesthepropertiesof an ideal material convenient for routine strabismus sur- gery. Seprafilm (Genzyme, Cambridge, MA) is a bioab- sorbablemembranecomposedofsodiumhyaluronateand carboxymethylcellulose. It has been used to decrease ad- hesions,mainlyinabdominalsurgery.Inaseriesoffour patients,Assaf 12 reportedthatSeprafilmwastoleratedwell by patients with ocular tissue having previous adhesions. Inthatreport,onlythetoleranceofSeprafilmwasevalu- ated, and it was suggested that Seprafilm might be a potentiallyusefulmaterialforstrabismussurgery.Tothe best of our knowledge, there are no reports about the histopathologiceffectofSeprafilminocularsurgery.The purpose of this study was to histopathologically evaluate theeffectofSeprafilmonpostoperativescarandadhesion formationinanexperimentalmodel. MATERIALS AND METHODS This study was performed after the approval of Animal Ethics Committee of Adnan Menderes University was gained. Seven adult male New Zealand albino rabbits weighing approximately 3 kg each were used. Xalazin hydrochloride (5mg/kg) and ketamine hydrochloride (3.5mg/kg)wereusedforanesthesia.Thelimbalconjunc- tiva was incised at the superior quadrant. The superior rectusmusclewasisolatedandsecuredwithamusclehook. Twoknotsusing6.0Vicryl(Ethicon)suturematerialwere placedonthesides3mmfromthemuscleinsertion.After From the Departments of Ophthalmology a and Pathology, b Adnan Menderes University Medical School, Aydın, Turkey. Previously presented at the 28th Meeting of the European Strabismological Association, Bergen, Norway, June 18-21, 2003. Submitted September 3, 2002. Revision accepted September 19, 2003. Reprint requests: Seyhan B. O ¨ zkan, Adnan Menderes Universitesi Tıp Faku ¨ltesi, Go ¨z Hastalıkları AD, 09010 Aydın, Turkey. Copyright © 2004 by the American Association for Pediatric Ophthalmology and Strabismus. 1091-8531/2004/$35.00 + 0 doi:10.1016/j.jaapos.2003.09.012 Journal of AAPOS 46 February 2004