The effect of the cell-derived extracellular matrix membrane on wound adhesions in rabbit strabismus surgery

The cell-derived extracellular matrix (ECM) membrane is a bio-absorbable membrane composed of aseptic ECM obtained from swine knee chondrocyte. The purpose of our study was to evaluate the inhibitory effect of the cell-derived ECM membrane in postoperative adhesion following strabismus surgery on rabbit eyes. Twenty four adult male New Zealand albino rabbits were used. Each rabbit has undergone 3 mm resection of the superior rectus muscle in both eyes. The cell-derived ECM membrane was applied between the conjunctiva and superior rectus muscle only to right eye in each rabbit. The eyes were divided into a surgery-ECM group and a surgery-no ECM group. The rabbits were sacrificed at 2, 4, and 6 weeks after the surgery. Each time, 16 eyes of 8 rabbits were enucleated to observe the adhesion in muscle and adjacent tissue grossly by blunt dissection. Then, histopathological sections were analyzed for inflammation and fibrosis by staining with hematoxylin-eosin and Masson trichrome, respectively. Inflammation and fibrosis were graded on a scale of 0 to 4. A researcher was blind to the experiments performed all the examinations. Comparing with the surgery-no ECM group, there was no significant difference with regard to inflammation at the area of superior rectus muscle resection at 2, 4, and 6 postoperative weeks (p = 0.52, p = 0.55, p = 0.82). However, a significant reduction in the degree of adhesion (p = 0.01, p = 0.03, p = 0.04) as well as decreased fibrosis (p = 0.04, p = 0.03, p = 0.02) between muscle and conjunctiva after strabismus surgery was observed in all surgery-ECM groups. The current results demonstrated that the cell-derived ECM membrane could inhibit the formation of postoperative adhesion and fibrosis between conjunctiva and muscle. The authors concluded that the use of ECM membrane could reduce postoperative adhesion around surgical area after strabismus surgery in rabbits.