Abstract
Purpose::
To investigate the potential use of the human amniotic membrane (HMA) antifibrotic properties as an adjuvant in glaucoma filtration surgery.
Methods::
50 eyes of 40 patients affected by primary open angle and angle closure glaucoma were enrolled in a comparative observational study. 20 eyes underwent limbus based trabeculectomy with transplantation of cryopreserved human amniotic membrane over the sceral flap (AMT group) and 30 eyes underwent standard trabeculectomy with out the use of any antimetabolites (NO AMT-control group). Preoperative mean IOP was 24 mmHg (range 22-34 mmHg) with 2 or more antiglaucoma medications. Main outcome measures were postoperative IOP, bleb formation and appearance, intra and postoperative complications. Initial success was determined as IOP<21 mmHg without any medications at 10 months follow-up. The two groups were compared using the 2 tailed T-test. Bleb appearance was evaluated according to the Moorfields Bleb Grading System.
Results::
At 10 months follow up mean IOP showed no statistical difference between the 2 groups (15.18 mmHg +/- 2.3 in the AMT group and 15.5 mmHg +/- 2.8 in the NO AMT group, p=0.063). Number of antiglaucoma medications after surgery was reduced equally in both groups. 1 case of encysted bleb was found in the AMT group (5.0 %) and in the NO AMT group (3.3%) respectively. There were no cases of endophtalmitis, leaking blebs or prolonged hypotony.
Conclusions::
Trabeculectomy with human amniotic membrane transplantation is safe and seems to achieve lower post-operative IOP compared to standard trabeculectomy at 10 months follow-up although the difference in the 2 groups is not statistically significant. This tendency requires further investigation to determine whether HAM should be used as an alternative treatment in wound healing modulation after trabeculectomy.
Keywords: wound healing • transplantation