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S.E. Moroi, J. Eisengart, C. Bruno; Use of Amniotic Membrane in Glaucoma Filtration Surgery . Invest. Ophthalmol. Vis. Sci. 2005;46(13):98.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To determine whether human amniotic membrane (AM) improves trabeculectomy results in eyes needing filtration surgery and to determine whether AM affects Tenon’s capsule fibroblast proliferation. Human AM has been successfully used in ocular surface reconstruction, but not in bleb leaks. We hypothesize that the anti–inflammatory, anti–angiogenic, and anti–fibrotic properties of AM improve trabeculectomy outcome in high–risk eyes. Methods: This study has both clinical and laboratory designs. The clinical study is a retrospective case series of patients who underwent either a trabeculectomy or a bleb revision with AM between 11/2003 and 10/2004. The laboratory arm is designed to measure the effect of AM on fibroblast growth. The proliferation of primary human Tenon’s capsule fibroblast cultures were measured using the 3–(4,5–dimethylthiazoly–2)–2,5–diphenyltetrazolium bromide (MTT) Cell Proliferation Assay (ATCC, Manassas, VA). Results: To date, in the clinical study 17 eyes of 15 patients (7 males and 8 females) were reviewed. There were 8 Whites, 6 Blacks, and 1 Hispanics. The average age was 62.4 years (range 17–73). Ocular diagnoses included: open–angle glaucoma (n=7), pseudoexfoliation (n=3), pigment dispersion (n=2), uveitis (n=3), congenital glaucoma (n=1), and iridocorneal endothelial syndrome (n=1). There were 1.5 prior incisional glaucoma surgeries (range 0–3). Mitomycin–C or 5–fluorouracil was used in 13 eyes. The average IOP was 27.0 + 9.1 mmHg, preoperatively, and 17.1 + 10.2 mmHg on the last post–operative visit (average follow–up was 95 days, range 11–325 days). The pre– and post–operative IOPs were statistically different (P=0.004, paired Student’s t test). At last exam, 2 eyes underwent glaucoma drainage implants, and 4 eyes resumed glaucoma medicines. Complications included conjunctival wound dehiscence with leak (n=5), which resolved, and postoperative iritis (n=1). In the laboratory, AM significantly decreased Tenon’s capsule fibroblast proliferation (p <0.05, ANOVA, Kruskal–Wallis test). Conclusions: Our short–term results in this case series of high–risk eyes suggest that AM may improve filtration outcome in high–risk eyes. Our preliminary laboratory findings support that AM slows Tenon’s capsule fibroblast proliferation. Amniotic membrane provides a promising means to augment the success rate of glaucoma filtering surgery in eyes at high–risk for failure.
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