Histologic and Immunohistochemical Evaluation of Radiosurgery in Strabismus Surgery in a Rabbit Model

Purpose The aim of this study was to evaluate the use of monopolar radiosurgery (MRS) assisted strabismus surgery and to compare its histologic and immunohistochemical wound healing outcomes with conventional surgery.Methods Superior rectus muscle resection was performed on 30 white rabbits with three different surgical muscle cutting techniques: monopolar radiosurgery (MRS group), conventional scissors preceded by bipolar electrocautery (BEC group), and conventional scissors with no cauterization (control group). Degree of tissue injury, bleeding, inflammation, and fibrosis, as well as wound healing rate (CD68+ cell number), were evaluated.Results In CS group, hemorrhage scores were significantly higher than those in the other groups (MRS group: Z = 5.182; p < 0.001 and BEC group: Z = 4.463; p < 0.001) and MRS group had lower scores than BEC group; however, the difference was not significant (Z = 1.423; p = 0.211). The tissue injury score in BEC group was higher when compared with MRS, and the difference was statistically significant (p = 0.028). Median inflammation scores at days 1 and 21 were lowest in MRS group, but the difference was not statistically significant among groups (day 1; p = 0.115, day 21; p = 0.095). The median fibrosis score was higher in the control group, when compared with MRS, and the difference was statistically significant (muscle–sclera; p = 0.011 and muscle–conjunctiva: p = 0.003). The macrophage score (number of CD68+ cells) was lowest in CS group; however, the difference was not significant (p = 0.657).Conclusions Monopolar radiosurgery is a novel method for strabismus surgery and provides equivalent hemostasis effects and wound healing properties, compared with conventional methods, and enhances surgeon comfort, as muscle incisions are made in one step with clean surgical area.