Trabeculectomy Following Surgical Reconstruction of Ocular Surface With Amniotic Membrane Transplantation

Abstract

Abstract: : Purpose: To evaluate the efficacy of amniotic membrane transplantation prior to glaucoma filtering surgery on the postoperative bleb formation and IOP control in human case and rabbit model. Methods: A limbal-based conjunctival incision was made as in usual glaucoma filtering surgery in the right eyes of 10 Japanese albino rabbits. Rabbit amniotic membrane (5X5 mm) was then sutured onto the sclera with 4 interrupted 9-0 nylon sutures. The incised conjunctiva was re-positioned with the same sutures. In the left eyes, only conunctival incisions and re-placement suturing were done and used as controls. One week later, sclerectomy was performed in both eyes. Postoperative intraocular pressure (IOP) and formation of filtering bleb were evaluated everyday for 1 week. The operated regions were examined histologically. A 22-year-old male patient underwent amniotic membrane transplantation for the cicatricial conjunctiva due to alkali injury. Eight months later, he developed secondary glaucoma for which we performed trabeculectomy. The postoperative condition was evaluated. Results: here was no significant difference in the postoperative IOP between the two groups. However, the eyes underwent sclerectomy with prior amniotic membrane transplantation showed better bleb formation with less conjunctival adhesion. Histologic examinations disclosed less subconjunctival fibrosis and inflammatory cell infiltration in eyes with amniotic membrane transplantation. During trabeculectomy of the clinical case, the conjunctiva was easily detached from the sclera, and the postoperative bleb formation and IOP control were good. Conclusions: Amniotic membrane transplantation prior to glaucoma filtering surgery is effective for good postoperative bleb formation even in eyes with cicatricial conjunctiva.

Keywords: transplantation • wound healing • animal model