Prevention of capsular contracture with Guardix-SG(®) after silicone implant insertion

A multi-targeting bionanomatrix coating to reduce capsular contracture development on silicone implants

BACKGROUND

Capsular contracture is a critical complication of silicone implantation caused by fibrotic tissue formation from excessive foreign body responses. Various approaches have been applied, but targeting the mechanisms of capsule formation has not been completely solved. Myofibroblast differentiation through the transforming growth factor beta (TGF-β)/p-SMADs signaling is one of the key factors for capsular contracture development. In addition, biofilm formation on implants may result chronic inflammation promoting capsular fibrosis formation with subsequent contraction. To date, there have been no approaches targeting multi-facted mechanisms of capsular contracture development.

METHODS

In this study, we developed a multi-targeting nitric oxide (NO) releasing bionanomatrix coating to reduce capsular contracture formation by targeting myofibroblast differentiation, inflammatory responses, and infections. First, we characterized the bionanomatrix coating on silicon implants by conducting rheology test, scanning electron microcsopy analysis, nanoindentation analysis, and NO release kinetics evaluation. In addition, differentiated monocyte adhesion and S. epidermidis biofilm formation on bionanomatrix coated silicone implants were evaluated in vitro. Bionanomatrix coated silicone and uncoated silicone groups were subcutaneously implanted into a mouse model for evaluation of capsular contracture development for a month. Fibrosis formation, capsule thickness, TGF-β/SMAD 2/3 signaling cascade, NO production, and inflammatory cytokine production were evaluated using histology, immunofluorescent imaging analysis, and gene and protein expression assays.

RESULTS

The bionanomatrix coating maintained a uniform and smooth surface on the silicone even after mechanical stress conditions. In addition, the bionanomatrix coating showed sustained NO release for at least one month and reduction of differentiated monocyte adhesion and S. epidermidis biofilm formation on the silicone implants in vitro. In in vivo implantation studies, the bionanomatrix coated groups demonstrated significant reduction of capsule thickness surrounding the implants. This result was due to a decrease of myofibroblast differentiation and fibrous extracellular matrix production through inhibition of the TGF-β/p-SMADs signaling. Also, the bionanomatrix coated groups reduced gene expression of M1 macrophage markers and promoted M2 macrophage markers which indicated the bionanomatrix could reduce inflammation but promote healing process.

CONCLUSIONS

In conclusion, the bionanomatrix coating significantly reduced capsular contracture formation and promoted healing process on silicone implants by reducing myfibroblast differentiation, fibrotic tissue formation, and inflammation. A multi-targeting nitric oxide releasing bionanomatrix coating for silicone implant can reduce capsular contracture and improve healing process. The bionanomatrix coating reduces capsule thickness, α-smooth muscle actin and collagen synthesis, and myofibroblast differentiation through inhibition of TGF-β/SMADs signaling cascades in the subcutaneous mouse models for a month.

Implantation and tracing of green fluorescent protein-expressing adipose-derived stem cells in peri-implant capsular fibrosis

BACKGROUND

Adipose-derived stem cells (ASCs) have been reported to reduce fibrosis in various tissues. In this study, we investigated the inhibitory role of ASCs on capsule formation by analyzing the histologic, cellular, and molecular changes in a mouse model of peri-implant fibrosis. We also investigated the fate and distribution of ASCs in the peri-implant capsule.

METHODS

To establish a peri-implant fibrosis model, customized silicone implants were inserted into the dorsal site of C57BL/6 wild-type mice. ASCs were harvested from the fat tissues of transgenic mice that express a green fluorescent protein (GFP-ASCs) and then injected into the peri-implant space of recipient mice. The peri-implant tissues were harvested from postoperative week 2 to 8. We measured the capsule thickness, distribution, and differentiation of GFP-ASCs, as well as the cellular and molecular changes in capsular tissue following ASC treatment.

RESULTS

Injected GFP-ASCs were distributed within the peri-implant capsule and proliferated. Administration of ASCs reduced the capsule thickness, decreased the number of myofibroblasts and macrophages in the capsule, and decreased the mRNA level of fibrogenic genes within the peri-implant tissue. Angiogenesis was enhanced due to trans-differentiation of ASCs into vascular endothelial cells, and tissue hypoxia was relieved upon ASC treatment.

CONCLUSIONS

We uncovered that implanted ASCs inhibit capsule formation around the implant by characterizing a series of biological alterations upon ASC treatment and the fate of injected ASCs. These findings highlight the value of ASCs for future clinical applications in the prevention of capsular contracture after implant-based reconstruction surgery.

Defining the Relationship Between Pocket and Breast Implant Surface Area as the Basis for a New Classification System for Capsular Contracture

BACKGROUND

The precise etiology and treatment for capsular contracture remains uncertain at least partially due to the fact that there is no reliable quantitative measurement tool. To address this, it is postulated that the surface area of an implant as defined by the surrounding pocket may provide a quantifiable variable that can be measured to evaluate the degree of capsular contracture.

METHODS

A bench model for capsular contracture was developed. The surface area of a series of spherical test objects and non-contracted and contracted breast implants was measured using a wax coating technique as well as three-dimensional reconstructions created from CT scan images.

RESULTS

Comparison of the mathematically calculated surface areas to the wax and CT results for spheres of known dimension provided nearly identical values documenting the accuracy of the two experimental methods. Comparison of the surface area measurements between the test groups showed that the average decrease in surface area for all implants was 20%, ranging from a high of 30.9% for a low profile implant to a low of 14.1 % for a high profile implant. The anatomically shaped devices demonstrated nearly uniform degrees of surface area change over three different heights with volume and projection held relatively constant.

CONCLUSIONS

The described bench model provides a useful tool for the study of capsular contracture. Surface area is a descriptive variable that can assess the degree of capsular contracture that is present. A classification system based on surface area is presented.

Modification of Alginates to Modulate Their Physic-Chemical Properties and Obtain Biomaterials with Different Functional Properties

Modified alginates have a wide range of applications, including in the manufacture of dressings and scaffolds used for regenerative medicine, in systems for selective drug delivery, and as hydrogel materials. This literature review discusses the methods used to modify alginates and obtain materials with new or improved functional properties. It discusses the diverse biological and functional activity of alginates. It presents methods of modification that utilize both natural and synthetic peptides, and describes their influence on the biological properties of the alginates. The success of functionalization depends on the reaction conditions being sufficient to guarantee the desired transformations and provide modified alginates with new desirable properties, but mild enough to prevent degradation of the alginates. This review is a literature description of efficient methods of alginate functionalization using biologically active ligands. Particular attention was paid to methods of alginate functionalization with peptides, because the combination of the properties of alginates and peptides leads to the obtaining of conjugates with properties resulting from both components as well as a completely new, different functionality.

Current Trends in Advanced Alginate-Based Wound Dressings for Chronic Wounds

Chronic wounds represent a major public health issue, with an extremely high cost worldwide. In healthy individuals, the wound healing process takes place in different stages: inflammation, cell proliferation (fibroblasts and keratinocytes of the dermis), and finally remodeling of the extracellular matrix (equilibrium between metalloproteinases and their inhibitors). In chronic wounds, the chronic inflammation favors exudate persistence and bacterial film has a special importance in the dynamics of chronic inflammation in wounds that do not heal. Recent advances in biopolymer-based materials for wound healing highlight the performance of specific alginate forms. An ideal wound dressing should be adherent to the wound surface and not to the wound bed, it should also be non-antigenic, biocompatible, semi-permeable, biodegradable, elastic but resistant, and cost-effective. It has to give protection against bacterial, infectious, mechanical, and thermal agents, to modulate the level of wound moisture, and to entrap and deliver drugs or other molecules This paper explores the roles of alginates in advanced wound-dressing forms with a particular emphasis on hydrogels, nanofibers networks, 3D-scaffolds or sponges entrapping fibroblasts, keratinocytes, or drugs to be released on the wound-bed. The latest research reports are presented and supported with in vitro and in vivo studies from the current literature.

Comparison of the Effects of Acellular Dermal Matrix and Montelukast on Radiation-Induced Peri-implant Capsular Formation in Rabbits

PURPOSE

Capsular contracture (CC) is a troublesome complication after breast surgery with breast implants, and the risk increases in breast cancer patients after radiotherapy. Studies investigating leukotriene antagonists (eg, montelukast, zafirlukast) found that the acellular dermal matrix (ADM) can help prevent CC. We aimed to compare the effects of ADM and montelukast on CC after irradiation.

METHODS

Eighteen New Zealand white rabbits were randomly divided into 3 groups of 6 each. Miniature cohesive gel implants were inserted into the pocket under the latissimus dorsi muscle. The lateral part was uncovered by the latissimus dorsi muscle. Six animals were included in the control group. In experimental group A (EG-A) (n = 6), the site was partially wrapped with ADM but not covered with muscle. Montelukast (Singulair, 0.2 mg/kg) was administered in experimental group B (EG-B) (n = 6) daily. Groups were irradiated at postoperative day 21 with Co-60 γ rays (25 Gy, single fraction) at the peri-implant area. Rabbits were sacrificed 12 weeks after surgery; implants with peri-implant capsule were harvested. Capsule thickness, collagen pattern, myofibroblast, and transforming growth factor (TGF) β1/2 levels in the peri-implant capsule were evaluated.

RESULTS

On histological evaluation, the capsule was thinner on the lateral aspect (covered with ADM) in EG-A (P = 0.004) and the entire capsule in EG-B (P = 0.004) than in the control group. However, there was no significant difference between EG-A and EG-B (P = 0.073). The collagen distribution pattern was more parallel with low density in the lateral capsular aspect in EG-A, but in the entire capsule in EG-B. The myofibroblast amount (EG-A, P = 0.031; EG-B, P = 0.016) and levels of TGF-β1 and TGF-β2 were reduced in the experimental groups (TGF-β1, EG-A, P = 0.019; TGF-β1, EG-B, P = 0.045; TGF-β2, EG-A, P = 0.018; TGF-β2, EG-B, P = 0.022). There was no significant difference between EG-A and EG-B (myofibroblast, P = 0.201; TGF-β1, P = 0.665; TGF-β2, P = 0.665).

CONCLUSIONS

Acellular dermal matrix and montelukast have a prophylactic effect for CC even when the breast is irradiated. There was no significant difference between ADM and montelukast in preventing capsular formation. The difference is that ADM will only have the effect of covering the capsular formation with ADM and montelukast can cause systemic effects or complications.

The effects of human amniotic membrane on silicone related capsule formation in rats

Silicone breast implants are commonly used materials in plastic surgery for breast augmentation and reconstruction and the most severe complication of silicone implants are capsule contraction which occurs in 40% of patients. The aim of our study is to evaluate how the amniotic membrane alters the capsule formation effects of silicone 24 wistar rats were used in the study. We placed a bare silicone block into the left side (Subgroup A) and single layer amniotic membrane coated silicone block into the right side (Subgroup B) of the rats back. The rats were then separated into three groups and in group 1 rats were euthanized after 3 weeks, in group 2 after 12 weeks and in group 3 after 24 weeks. Then capsule thickness, fibroblast and lymphocyte cell counts were evaluated for each sample. In Group 2 and group 3, the capsule thickness in Subgroup B was detected to be statistically significantly lower than that in Subgroup A. In Group 1, 2, and 3, the lymphocyte count in the capsule tissue taken from Subgroup B was lower than Subgroup A but the difference was not statistically significant. In Group 2 and 3, the fibrocyte count detected in the capsule tissue in Subgroup B was found to be statistically significantly lower than Subgroup A. the amniotic membrane was demonstrated to reduce capsule thickness by the antifibrinolytic effect in our study.

Recent Advances in Pharmaceutical Potential of Brown Algal Polysaccharides and their Derivatives

Marine plants, animals and microorganisms display steady growth in the ocean and are abundant carbohydrate resources. Specifically, natural polysaccharides obtained from brown algae have been drawing increasing attention owing to their great potential in pharmaceutical applications. This review describes the structural and biological features of brown algal polysaccharides, including alginates, fucoidans, and laminarins, and it highlights recently developed approaches used to obtain the oligo- and polysaccharides with defined structures. Functional modification of these polysaccharides promotes their advanced applications in biomedical materials for controlled release and targeted drug delivery, etc. Moreover, brown algal polysaccharides and their derivatives possess numerous biological activities with anticancer, anticoagulant, wound healing, and antiviral properties. In addition, we also discuss carbohydrate- based substrates from brown algae, which are currently in clinical and preclinical studies, as well as the marine drugs that are already on the market. The present review summarizes the recent development in carbohydratebased products from brown algae, with promising findings that could rapidly facilitate the future discovery of novel marine drugs.

Silicone breast implant modification review: overcoming capsular contracture

Background

Silicone implants are biomaterials that are frequently used in the medical industry due to their physiological inertness and low toxicity. However, capsular contracture remains a concern in long-term transplantation. To date, several studies have been conducted to overcome this problem. This review summarizes and explores these trends.

Main body

First, we examined the overall foreign body response from initial inflammation to fibrosis capsule formation in detail and introduced various studies to overcome capsular contracture. Secondly, we introduced that the main research approaches are to inhibit fibrosis with anti-inflammatory drugs or antibiotics, to control the topography of the surface of silicone implants, and to administer plasma treatment. Each study examined aspects of the various mechanisms by which capsular contracture could occur, and addressed the effects of inhibiting fibrosis.

Conclusion

This review introduces various silicone surface modification methods to date and examines their limitations. This review will help identify new directions in inhibiting the fibrosis of silicone implants.

Application of thermoreversible hydrogel (poloxamer 407) to protect the corneal endothelium during phacoemulsification in porcine and rabbit eyes

PURPOSE

To evaluate the effectiveness of thermoreversible (poloxamer) hydrogels as a substitute for ophthalmic viscosurgical devices (OVDs) during phacoemulsification in porcine and rabbit eyes and compare their endothelial protective effect with that of hyaluronic acid-based OVDs.

SETTING

Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.

DESIGN

Experimental study.

METHODS

Fluorescein-stained poloxamer hydrogels (20%, 22%, 24%, and 26% [weight/weight%]) and cohesive (sodium hyaluronate 1.0% [Provisc]) and dispersive (sodium hyaluronate 3.0%-chondroitin sulfate 4.0% [Viscoat]) OVDs were injected into the anterior chamber of porcine eyes incubated at 32°C. In the in vitro study, the retention time was measured in 3 groups of 45 porcine eyes during continuous phacoemulsification. In the in vivo study, the endothelial cell count (ECC) was measured before and 3 days after intermittent phacoemulsification in 12 rabbit eyes randomized to a poloxamer hydrogel or a dispersive OVD group.

RESULTS

The optimum concentration of thermosensitive hydrogel was 26%, at which no gel-to-sol phase transition occurred in the anterior chamber, with a 21°C irrigation solution. In the in vitro study, the mean retention times were 5.53 seconds ± 1.77 (SD), 125.00 ± 29.34 seconds, and 221.53 ± 42.48 seconds in the cohesive OVD, dispersive OVD, and 26% poloxamer hydrogel groups, respectively (P < .001). Throughout the 5-minute intermittent phacoemulsification, the 26% poloxamer hydrogel remained in the anterior chamber as a semisolid gel. In the in vivo study, the mean decrease in ECC was significantly lower in the 26% poloxamer hydrogel group than in the dispersive OVD group (P = .029).

CONCLUSION

Thermoreversible hydrogels might be suitable substitutes for hyaluronic acid-based OVDs for corneal endothelial protection during phacoemulsification.

The Effects of Colchicine-Impregnated Oxidized Regenerated Cellulose on Capsular Contracture

Capsular contracture is the most common complication of breast augmentation. Oxidized regenerated cellulose can be used as a matrix for drug transport. Colchicine is an antimitotic drug that interferes with various steps of wound healing. The aim of this study was to evaluate the effects of oxidized regenerated cellulose alone or in combination with colchicine on capsular contracture. Twenty-one adult female Wistar-Albino rats were divided into 3 groups. In group 1 silicone blocks only, in group 2 oxidized regenerated cellulose-wrapped silicone blocks, and in group 3 colchicine-impregnated oxidized regenerated cellulose-wrapped silicone blocks were inserted in the dorsal region. Four weeks later, implants were removed and histopathological examination was performed. Capsular thickness, inflammatory infiltrate degree, collagen fiber organization, and myofibroblast density were evaluated. Macroscopic examination revealed a distinct capsule formation only in group 1 animals, with average measurement being 134.65 µm on histopathological examination. In groups 2 and 3 animals, no distinct capsule formation was seen. Inflammatory infiltrate degree was found to be less in groups 2 and 3 animals than in group 1 animals. Collagen fiber organization around the implants was found to be parallel and organized in group 1 animals, whereas it was random and disorganized in animals in both groups 2 and 3. High myofibroblast density was observed in animals in groups 1 and 2, while no myofibroblast was found in animals in group 3. The results of our study suggest that coating silicone implants with oxidized regenerated cellulose or with colchicine-impregnated oxidized regenerated cellulose may be effective in preventing capsular contracture.

Influence of anti-adhesive agent on incidence of bile leakage after liver resection: A prospective cohort study

BACKGROUND

Anti-adhesive agents are increasingly used to reduce the incidence of postoperative adhesions following abdominal surgery. Bile leakage after liver resection remains a major cause of postoperative morbidity. The aim of this study was to examine the effect of anti-adhesive agent on bile leakage after liver resection.

MATERIALS AND METHODS

77 patients were enrolled to receive an anti-adhesive agent (study group) during liver resection between May 2012 and August 2013. The study group was compared to a match-paired control group. Clinical data were collected including bilirubin concentration in serum and drain fluid and bile leakage rate. In addition, a separate analysis was performed between patients with and without postoperative bile leakage.

RESULTS

There was no difference in bile leakage rate or hospital stay between the study group (n = 77) and control group (n = 77). Of the total number of patients (n = 154), there were 29 patients with postoperative bile leak and 125 patients without bile leak. On univariate analysis, patients without history of hepatitis were significantly associated with bile leakage. In addition, liver resection with broader cut surface area was associated with bile leakage. Application of anti-adhesive agent was not associated with bile leakage. On multivariate analysis, resection with broader cut surface area (OR = 2.788, p = 0.026) and patients without history of hepatitis (OR = 5.153, p = 0.039) were significantly associated with bile leakage.

CONCLUSIONS

Larger area of cut-surface and patients without history of hepatitis were significant risk factors for bile leakage. The use of anti-adhesive agent was not associated with increased risk of bile leakage.

Effects of a Temperature-Sensitive, Anti-Adhesive Agent on the Reduction of Adhesion in a Rabbit Laminectomy Model

OBJECTIVE

A common cause of failure in laminectomy surgery is when epidural, peridural, or perineural adhesion occurs postoperatively. The purpose of this study is to examine the efficacy of a temperature-sensitive, anti-adhesive agent (TSAA agent), Guardix-SG®, as a mechanical barrier for the prevention or reduction of peridural scar adhesion in a rabbit laminectomy model.

METHODS

Twenty-six mature rabbits were used for this study. Each rabbit underwent two separate laminectomies at lumbar vertebrae L3 and L6, left empty (the control group) and applied 2 mL of the TSAA agent (the experimental group), respectively. Invasive scar formation or inflammation after laminectomy was quantitatively evaluated by measuring the thickness of the dura, the distance from the surface of dura to the scar tissues, the number of inflammatory cells in the scar tissues at the laminectomy site, and the concentration of collagen in histological sections.

RESULTS

At 6 weeks postsurgery, the dura was significantly thinner and the distance from the surface of dura to the scar tissues was greater in the experimental group than in the control group (p=0.04 and p=0.01). The number of inflammatory cells was not significantly different in the two groups (p=0.08), although the mean number of inflammatory cells was relatively lower in the experimental group than in the control group.

CONCLUSION

The current study suggests that the TSAA agent, Guardix-SG®, could be useful as an interpositional physical barrier after laminectomy for the prevention or reduction of adhesion.

Alginate: Current Use and Future Perspectives in Pharmaceutical and Biomedical Applications

Over the last decades, alginates, natural multifunctional polymers, have increasingly drawn attention as attractive compounds in the biomedical and pharmaceutical fields due to their unique physicochemical properties and versatile biological activities. The focus of the paper is to describe biological and pharmacological activity of alginates and to discuss the present use and future possibilities of alginates as a tool in drug formulation. The recent technological advancements with using alginates, issues related to alginates suitability as matrix for three-dimensional tissue cultures, adjuvants of antibiotics, and antiviral agents in cell transplantation in diabetes or neurodegenerative diseases treatment, and an update on the antimicrobial and antiviral therapy of the alginate based drugs are also highlighted.

Effect of Temperature-Sensitive Poloxamer Solution/Gel Material on Pericardial Adhesion Prevention: Supine Rabbit Model Study Mimicking Cardiac Surgery

Objective

We investigated the mobility of a temperature-sensitive poloxamer/Alginate/CaCl₂ mixture (PACM) in relation to gravity and cardiac motion and the efficacy of PACM on the prevention of pericardial adhesion in a supine rabbit model.

Methods

A total of 50 rabbits were randomly divided into two groups according to materials applied after epicardial abrasion: PACM and dye mixture (group PD; n = 25) and saline as the control group (group CO; n = 25). In group PD, rabbits were maintained in a supine position with appropriate sedation, and location of mixture of PACM and dye was assessed by CT scan at the immediate postoperative period and 12 hours after surgery. The grade of adhesions was evaluated macroscopically and microscopically two weeks after surgery.

Results

In group PD, enhancement was localized in the anterior pericardial space, where PACM and dye mixture was applied, on immediate post-surgical CT scans. However, the volume of the enhancement was significantly decreased at the anterior pericardial space 12 hours later (P < .001). Two weeks after surgery, group PD had significantly lower macroscopic adhesion score (P = .002) and fibrosis score (P = .018) than did group CO. Inflammation score and expression of anti-macrophage antibody in group PD were lower than those in group CO, although the differences were not significant.

Conclusions

In a supine rabbit model study, the anti-adhesion effect was maintained at the area of PACM application, although PACM shifted with gravity and heart motion. For more potent pericardial adhesion prevention, further research and development on the maintenance of anti-adhesion material position are required.

Understanding the Etiology and Prevention of Capsular Contracture: Translating Science into Practice

Capsular contracture remains a common and preventable complication of implanted breast prostheses. As our understanding of the pathophysiology continues to develop, it is prudent to reexamine existing beliefs in a contemporary context. This article presents a current summary of clinical and laboratory evidence, expressed as an interaction between potentiating and suppressing factors, and how this understanding can be applied to practice.

Effect of Antiadhesion Barrier Solution and Fibrin on Capsular Formation After Silicone Implant Insertion in a White Rat Model

INTRODUCTION

One of the most serious complications of breast reconstruction and augmentation using silicone implants is capsular contracture. Several preventive treatments, including vitamin E, steroids, antibiotics, and cysteinyl leukotriene inhibitors, have been studied, and their clinical effects have been reported. However, the problem of capsular contracture has not yet been completely resolved. This study was performed to compare anti-adhesion barrier solution (AABS) and fibrin in their ability to prevent fibrotic capsule formation and simultaneously evaluated their effect when used in combination by capsular thickness analysis and quantitative analysis of matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), and type I collagen within the fibrous capsule.

MATERIALS AND METHODS

This study used female six-week-old Sprague-Dawley rats. Eighty rats were equally subdivided into the four following groups: AABS-treated, fibrin-treated, AABS and fibrin combined-treated, and untreated control groups. Each rat received two silicone chips under the panniculus carnosus muscle layer. The test materials were applied around the silicon chips. Four weeks later, the implantation sites including the skin and muscle were excised to avoid the risk of losing the fibrous capsule around the implants. The capsular thickness was analyzed by Masson's trichrome stain. Quantitative analysis of type I collagen, MMPs, and TIMPs was performed by real-time PCR, Western blot, and zymography.

RESULTS

The mean capsular thickness was 668.10 ± 275.12 μm in the control group, 356.97 ± 112.11 μm in the AABS-treated group, 525.96 ± 130.97 μm in the fibrin-treated group, and 389.24 ± 130.51 μm in the AABS and fibrin combined-treated group. Capsular thickness was significantly decreased in all experimental groups (p < 0.05). Capsular thickness was greater in the fibrin-treated group than in the AABS-treated group (p < 0.05). There was no statistically significant difference in capsular thickness between the AABS and fibrin combined-treated group and the AABS- or fibrin-treated group (p > 0.05). Compared to the control group, the experimental groups had significantly lower expressions of type I collagen and MMP-1 (p < 0.05), but there was no statistically significant difference in expressions of type I collagen and MMP-1 between the AABS-, fibrin-, and AABS and fibrin combined-treated groups (p > 0.05). The expressions of MMP-2 and TIMP-2 were not significantly different between the control and the experimental groups (p > 0.05).

CONCLUSION

AABS is more effective in reducing capsular thickness compared with fibrin treatment in a white rat model.