Abstract
Purpose: :
Although usefulness of amniotic membrane for filtration surgery in patients with refractory glaucoma has been widely reported, it is known that in some eyes the membrane does not work well because of fibroblastic overgrowth at the edge of the amniotic membrane. We introduce a new technique of bleb reconstruction using silicon sponge rapped with amniotic membrane with its outcomes.
Methods: :
The surgical technique includes first conjunctival synechiotomy with a limbus-based conjunctival incision and following re-opening the former trabeculectomy flap. Then a silicone sponge with 1.5 mm wide and 12 mm long rapped 3 times with amniotic membrane is placed longitudinally and sutured on the sclera. The anterior end of the amniotic membrane is fixed underneath the scleral flap by 10-0 nylon sutures. After that the conjunctival flap is closed. The surgery was performed on 7 eyes having more than twice glaucoma surgery (2-4 times) from 7 male patients (average age; 62 years old). The follow-up periods were from 6 to 22 months (average; 10.6 months).
Results: :
The preoperative intraocular pressures (IOPs) ranged from 20 to 50 mmHg (average; 33.7 mmHg). The most recent IOPs were less than 19 mmHg with anti-glaucoma eye drops in all eyes except one. In one eye with neovascular glaucoma IOP was 25 mmHg with hyphema in 10 months after the surgery. In early postoperative stage, 2 eyes had aqueous leaking via the conjunctival wound. To stop the leakage 1 eye required an amniotic membrane patch covering the leakage and the other had trabeculectomy in the different portion. In 2 eyes, bleb needling was effective for bleb revision.
Conclusions: :
Reconstruction of the non-functional trabeculectomy bleb using a silicone sponge rapped with amniotic membrane can be a useful strategy for refractory glaucoma.This study was approved by the review board/ethics committee of the University of Occupational and Environmental Health, Japan, and informed consents were obtained from the patients before the surgery.
Keywords: clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials