Nuray Akyol

Effects of Amniotic Membrane Transplantation and Mitomycin C on Wound Healing in Experimental Glaucoma Surgery

Purpose: To evaluate the effects of mitomycin C and amniotic membrane transplantation on the modulation of wound healing after glaucoma filtration surgery. Methods: Trabeculectomy was performed in 3 groups of 10 rabbit eyes each. Sponges soaked in mitomycin C were applied to the first group, and amniotic membranes were transplanted around the scleral flap in the second group; the third group was the control. The arithmetic means of fibroblast and macrophage numbers per square centimetre were calculated. Results: The mean numbers of fibroblasts and macrophages were decreased significantly in the mitomycin C group, compared with the controls (p < 0.0001). Cell counts in the amniotic membrane group were also lower than the ones in the control group for fibroblasts and macrophages (p < 0.0001, p < 0.01, respectively). The difference between the two treatment groups was statistically significant for fibroblasts (p < 0.0001), but not significant for macrophages (p > 0.05). Conclusion: In spite of the fact that amniotic membrane transplantation is less effective than mitomycin C for depressing wound healing after trabeculectomy, it might be a safer alternative in selected cases when considering severe adverse effects of antimetabolites.

Effects of octreotide acetate and amniotic membrane on wound healing in experimental glaucoma surgery

Wound healing affects the success of glaucoma filtering surgery. Antimetabolites and antifibrotic agents are used in the modulation of surgical trauma. This study is performed to evaluate the effects of amniotic membrane and octreotide acetate on wound healing . Thirty pigmented rabbits were divided into three groups each including 10 animals. Trabeculectomy and topical postoperative prednisolone sodium phosphate four times daily for 7 days were applied to one eye of all the rabbits. After trabeculectomy, octreotide 10 μg three times daily applied topically to the octreotide group for 14 days and amniotic membrane transplantation was performed by suturing amniotic membrane between scleral flap and sclera to the amniotic membrane group. The operated eyes of the rabbits were enucleated on the 14th day of the operation and histopathological specimens were obtained from the bleb sites and they were evaluated by light microscope. Fibroblast and macrophage number per cm2 were counted and the average values were calculated. Compared with the control group, the fibroblasts and macrophages significantly decreased in the other two groups (p < 0.0001, p < 0.0001, respectively). The mean number of fibroblasts was lower than those of the control and amniotic membrane groups (p < 0.0001, p < 0.0001, respectively). Similarly the mean macrophage number was significantly lower in the octreotide group versus the control and amniotic membrane groups (p < 0.0001, p < 0.01, respectively). Octreotide administration and amniotic membrane transplantation might be alternative treatments in modulating the wound healing after trabeculectomy.

Effects of intraoperative oxidated regenerated cellulose on wound healing reaction after glaucoma filtration surgery: A comparative study with Interceed and Surgicel

Background: The successful lowering of the intraocular pressure after glaucoma filtration surgery depends mostly on the nature of the healing response, which is also the single most important modifiable factor. Aims: To evaluate and compare the effectiveness of two oxidated regenerated cellulose material, Interceed and Surgicel on wound healing reaction after glaucoma filtration surgery. Setting and Design: University hospital, prospective study. Materials and Methods: Full thickness filtration surgery was carried out on three groups of rabbits. Interceed and Surgicel was applied in Groups 1 and 2 respectively. The third group was the controls. Intraocular pressure, anterior chamber depth and bleb appearance were checked on the first, third, seventh and 14th days. The rabbits were sacrificed on the14th day and the trabeculectomy area with overlying conjunctiva was excised, fixed, stained and evaluated histopathologically. Statistics: The values obtained from the clinical and histopathologic evaluation were statistically analyzed using non-parametric tests (Mann Whitney-U and Kruskall Wallis tests) in SPSS for Windows v-10. P values under 0.05 for statistical significance in comparisons were considered significant. Results The groups were similar with respect to intraocular pressure, anterior chamber depth, bleb appearance and number of the fibroblasts and neutrophils on the seventh and 14th days. Mean number of the eosinophils and vessels was significantly less in Groups 1 and 2 (P = 0.014, P = 0.20 respectively). Macrophages in Group 2 were significantly less than Group 1 (P = 0.047). Conclusion Both these agents seem to suppress vascularization. Since they have no significant effect on fibroblast proliferation, it is controversial to talk about wound healing modulation.

Effects of Systemic Octreotide, Local Mytomycine-C and Local Corticosteroids on Wound-Healing Reaction after Glaucoma Surgery

Purpose: To determine and compare the effectiveness of octreotide,mitomycine-C and corticosteroids on wound-healing reaction after glaucomasurgery. Methods: A full thickness scleral trephination was carriedout by the same surgeon on tour groups of six rabbits. A sponge soaked inmytomicine-C was applied subconjunctivally in group 1 before trephination.Group 2 received corticosteroid drops tid topically for 14 days. Group 3 received subcutaneous octreotide injections tid for 14 days. The controlgroup (group 4) was not given any drug that may interfere with wound healing.All groups received gentamycine drops tid for seven days. The rabbits wereSacrificed on the fourteenth day and the trephination area with overlyingconjunctiva was excised. The samples were prefixed with glutaraldehyde,dehydrated and embedded in Araldite Cy 212. Ten semithin sections stainedwith toluidin blue were analysed for each group. Fibroblast and macrophagecounts were performed on the surgical site and subconjunctival area.Results: Intensive fibroblastic activity, increased number of vessels andactive macrophages were observed only in group 4. The fibroblast and macrophagedensities in this group were significantly higher than the other three groups inwhich wound healing was modulated (p < 0.001). Mean number of fibroblasts ingroup 1 was also significantly less than the ones of groups 2 and 3(p < 0.01). Macrophage densities were similar in groups 1, 2 and 3. No statistical significance was found between groups 2 and 3 by means offibroblast and macrophage densities. Conclusion: Octreotide reducedwound-healing reaction in a similar fashion to corticosteroids ormitomycine-C. These initial results seem promising.

Effects of membrane adhesion barriers on wound healing reaction after glaucoma filtration surgery: a comparative study with Interceed and Seprafilm.

Purpose To evaluate and compare the effectiveness of two adhesion barriers, Interceed and Seprafilm, on wound healing reaction after glaucoma filtration surgery. Materials and Methods Full-thickness filtration surgery was carried out on three groups, each containing four rabbits. Interceed and Seprafilm prepared in 3×4 mm dimensions was put on and around scleral opening in Groups 1 and 2, respectively. All groups received tobramycin and dexamethasone drops tid for 14 days. Intraocular pressure (IOP), anterior chamber depth, and bleb appearance were checked on the first, third, seventh, and 14th days. The rabbits were killed on the 14th day and the trabeculectomy area with overlying conjunctiva was excised. The samples were fixed with 10% formalin, buried in paraffin, and stained with hematoxylin and eosin. The surgical site and surrounding subconjunctival area were evaluated histopathologically for cell counts (fibroblast, lymphocyte, eosinophil, and macrophage), presence of edema and foreign body reaction, and potency of the fistula tract. Results Mean IOP at the first and third day examinations was significantly different between groups, but there was no statistically significant difference among the groups with respect to IOP, anterior chamber depth, or bleb appearance at the seventh and 14th days. The groups were similar with respect to number of fibroblasts, eosinophils, and neutrophils. Number of macrophages was significantly increased in Groups 1 and 2 and number of vessels was significantly decreased in Group 1. Conclusions Neither of these two adhesion-preventing substances seems to suppress wound healing reaction after glaucoma filtration surgery. However, a diminished wound healing reaction was expected with a decreased number of vessels, such as in Group 1. Increased number of macrophages in both groups may result in a decreased level of some inflammatory mediators.