The effect of fibrin glue on suppressing Transforming Growth Factor-β (TGF-β) expression compared to Mitomycin-C (MMC) and Triamcinolone Acetonide (TCA) as antifibrotic agents in contracted socket prevention

Background: Post-evisceration fibrosis remains the leading cause of contracted socket. The application of fibrin glue is considered an alternative adjuvant therapy in suppressing profibrotic factor (TGF-β) expression following evisceration surgery to prevent contracted socket. This study aimed to know the role of fibrin glue in suppressing the TGF-β expression following evisceration surgery. Methods: An in vivo experimental study with a randomized post-test-only control group using twenty New Zealand rabbits were conducted. The sample was divided into four groups, each consisting of five rabbits, and one healthy eye was selected randomly for evisceration. Each rabbit in the study group was given a subconjunctival injection of agents corresponding to each study group, namely: Group I (control [no injection]), Group II (0.1 ml MMC 0.4 mg/ml), Group III (0.1 ml TCA 40 mg/ml), and Group 4 (0.1 ml fibrin glue) at the inferior fornix. Following a 14-day observation period, the animals were euthanized, and tenon conjunctiva in inferior fornix samples was collected for immunohistochemistry (IHC) staining examination. The pathologist calculates the immunoreactive scores (IRS) for each specimen. The differences in TGF-β expression were statistically analyzed with a significant p<0.05. Data were analyzed using SPSS version 26 for Windows. Result: The highest TGF-β expression was found in the control group (I), and the lowest was in the mitomycin-C group (III), followed by the triamcinolone group (IV) and fibrin glue group (II). There were significant differences in TGF-β expression among the four groups (p=0.004). The difference between fibrin glue, MMC, and triamcinolone acetonide groups was insignificant (p>0.05). Conclusion: As an alternative to mitomycin-C and triamcinolone acetonide, fibrin glue can be used as adjuvant therapy to prevent constricted sockets after evisceration.