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Keith Barton, Donald L. Budenz, Peng T. Khaw, Scheffer C. G. Tseng; Glaucoma Filtration Surgery using Amniotic Membrane Transplantation. Invest. Ophthalmol. Vis. Sci. 2001;42(8):1762-1768.
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purpose. To investigate the potential use of amniotic membrane transplantation
(AMT) in the construction of glaucoma filtering blebs.
methods. Twenty-four albino rabbits underwent glaucoma filtration surgery in one
eye. In alternate cases, the conjunctival flap was replaced with AMT.
Postoperative examination data were grouped into three time points. Six
animals with AMT and six filtration surgery-controls were euthanatized
at each of two postoperative time points, and tissue was obtained for
histologic examination. Conjunctival biopsies were explanted for
estimation of fibroblast outgrowth.
results. Bleb formation was observed in all eyes, and amniotic membranes were
epithelialized after 11.2 ± 2.48 (mean ± SD) days.
Throughout the study IOPs were significantly lower in operated than
unoperated fellow eyes. Between postoperative days 11 and 16 (the
middle time point), the percentage IOP reduction in AMT eyes was
significantly greater than in filtration surgery controls
(P = 0.014), though not at other time points.
Filtration surgery survival was significantly longer in the AMT group
(22.3 ± 3.8 days; mean ± SE) than in “No AMT” controls
(14.0 ± 1.6 days; P = 0.035). In tissue
culture, significantly less fibroblast outgrowth occurred from AMT
explants when compared with unoperated conjunctiva
(P = 0.01) between postoperative days 3 and 9 (the
early time point). Amniotic membrane transplants were intact on
histologic examination after 14 days but were associated with
considerable granulomatous inflammation. After 36 days, the ocular
surfaces remained clinically intact, but lysis of AMT was noted
conclusions. AMT exhibits potential as an alternative tissue to conjunctiva in the
construction of glaucoma filtration blebs. The healing response as
demonstrated by fibroblast outgrowth is retarded when compared with
conventional conjunctival closure. The improvement in bleb survival
must be weighed against the potential for complications related to
delayed healing. In rabbits, human amniotic membrane elicited a late
xenograft reaction, leading to granulomatous inflammation and
dissolution of the membrane.
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