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    Novel Bacterial Cellulose Membrane to Reduce Fibrosis Following Trabeculectomy
    (Lippincott Williams & Wilkins, 2021) Yazgan, Serpil; Tekin, Ishak Ozel; Akpolat, Nusret; Koc, Ozhan
    Purpose: The aim was to evaluate the effectiveness of bacterial cellulose membrane (BCM) in preventing fibrosis in trabeculectomy and the biocompatibility of BCM with conjunctiva and sclera. Materials and Methods: Twenty-one eyes of 21 adult rabbits underwent fornix-based trabeculectomy. Standard surgery was done to control group (CG, n = 7). Mitomycin-C (MMC) (0.3 mg/mL, 3 min) was applied to MMC group only (MMCG, n = 7). BCM (similar to 100 mu m thick, 10x 10 mm, single layer) was covered on the sclerotomy area before conjunctiva was closed in BCM group (BCMG, n = 7). Intraocular pressures (TOP) 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 number, degrees of fibrosis, total inflammation, foreign body reaction, inflammatory cell types (B cells, T cells, plasma cells), macrophages, bleb spaces and the expression of a-smooth muscle actin 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 conjunctival vessel 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 foreign body reaction in the BCMG. There was mild to moderate inflammation in all BCM cases. While fibrosis and alpha-smooth muscle actin staining were higher in the CG (P < 0.001), they were minimal in the BCM and MMCGs. Conclusions: BCM showed good biocompatibility and provided better control of IOP with minimal fibrosis at the trabeculectomy site compared with the control group.