title: Suramin, Genistein and Collagen Matrix (DuraGen) for Delayed Adjustment after Strabismus Surgery: Which One is Best?
abstract: OBJECTIVE
  To evaluate the efficacy and safety of suramin, genistein and collagen matrix for the prevention of inflammation, the reduction of fibrosis and the delay in adjustment after strabismus surgery on a rabbit model.
  
  
  METHODS
  By using an adjustable suture technique, a recession of the superior rectus muscle (SRM) was made in 36 eyes of 18 rabbits. Three study groups were created using genistein, suramin and collagen matrix (n = 6 per group). Two control groups utilized dimethyl sulphoxide (DMSO) (n = 6) and balanced salt solution (n = 12). The adjustments and measurements were made on days 2, 7, 14. After enucleation was done on day 21, the degree of inflammation was evaluated quantitatively in histopathological sections and immunohistochemical investigations were performed for tissue expression of cytoplasmic vascular endothelial growth factor (VEGF), MAC 387, TGF-β and bFGF.
  
  
  RESULTS
  The adhesions between conjunctiva and SRM were significantly less in the collagen matrix and suramin groups (p = 0.002) and adhesions between the sclera and SRM were considerably reduced in the genistein and DMSO groups (p = 0.006) on day 7. Force exerted for adjustment was significantly less in the collagen matrix and suramin groups on day 14 (p = 0.006). Expression of b-FGF was significantly lower in the conjunctival epithelium in the suramin and genistein groups (p = 0.0001 for both). TGF-β was significantly lower (p = 0.001) in the suramin group and VEGF expression was totally absent. MAC 387 expression was lower in the genistein and suramin groups (p = 0.0001).
  
  
  CONCLUSIONS
  Suramin, genistein and collagen matrix successfully reduce adhesions, and facilitate adjustment following recession surgery. Both suramin and genistein effectively suppress growth factor expression, while collagen matrix offers the longest time interval for adjustability after strabismus surgery.
authors: a Department of Ophthalmology , Ahi Evran University Education and Research Hospital , Kirsehir , Turkey .
authors: Caglar
authors: C
authors: Oktem
authors: b Department of Ophthalmology , Baskent University Hospital , Ankara , Turkey .
authors: Sibel
authors: S
authors: Oto
authors: c Department of Pathology , Akdeniz University Hospital , Antalya , Turkey .
authors: Serap
authors: S
authors: Toru
authors: d Department of Public Health , Canakkale Onsekiz Mart University Hospital , Canakkale , Turkey .
authors: Coskun
authors: C
authors: Bakar
authors: e Department of Pathology , Baskent University Hospital , Ankara , Turkey , and.
authors: Handan
authors: H
authors: Ozdemir
authors: f Department of Ophthalmology , Bayındır Hospital , Ankara , Turkey.
authors: Yonca Aydin
authors: YA
authors: Akova
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000378:metabolism; D003094:Collagen / Q000627:therapeutic use*; D003228:Conjunctiva / Q000378:metabolism; D000071063:Endoglin / Q000378:metabolism; D004848:Epithelium / Q000378:metabolism; D005260:Female; D005355:Fibrosis / Q000517:prevention & control; D019833:Genistein / Q000627:therapeutic use*; D007249:Inflammation / Q000517:prevention & control; D008297:Male; D009801:Oculomotor Muscles / Q000187:drug effects*; D013508:Ophthalmologic Surgical Procedures; D011817:Rabbits; D013285:Strabismus / Q000601:surgery*; D013498:Suramin / Q000627:therapeutic use*; D013536:Suture Techniques; D016212:Transforming Growth Factor beta / Q000378:metabolism; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D000071063:Endoglin; D016212:Transforming Growth Factor beta; D042461:Vascular Endothelial Growth Factor A; D013498:Suramin; D003094:Collagen; D019833:Genistein
keywords: Adjustable suture; collagen matrix (DuraGen); genistein; suramin