Use of Amniotic Membrane in MMC-Augmented Trabeculectomy: A Retrospective Comparative Study

Abstract

Purpose: Amniotic membrane transplantation (AMT) has shown promising results as an antifibrotic agent in trabeculectomy. We aimed to evaluate the additional effect of AMT in MMC-augmented trabeculectomy. Patients and Methods: This retrospective study analyzed the results of the first 12 postoperative months of glaucomatous eyes submitted to Moorfields Safer Surgery Trabeculectomy with MMC alone (non-AMT group) compared to MMC and AMT (AMT group). Both groups were compared in terms of intraocular pressure (IOP), number of antihypertensive medications and need for surgical reinterventions. Absolute and relative success rates 12 months after surgery were defined as IOP <18 mmHg, without and with the use of antihypertensive medications, respectively. Results: The analysis included 51 eyes of 45 glaucoma patients (29 eyes in the non-AMT group and 22 in the AMT group). Mean IOP decreased from 24.72±5.11 mmHg and 26.86 ±10.62 mmHg preoperatively in non-AMT and AMT groups to 12.86±4.22 mmHg and 12.60 ±4.43 mmHg, respectively, at 12 months (p = 0.84). Postoperative number of medications decreased significantly in both groups. Absolute success was seen in 71% of non-AMT eyes and 55% of AMT eyes (p = 0.46), whereas relative success was obtained in 14% and 30%, respectively (p = 0.55). Reinterventions were needed in 28% of the eyes (11 bleb injection/ needling and 4 Ahmed tube implantation) in the non-AMT group and in 27% of the AMT group (10 bleb injection/needling and 1 Ahmed tube implantation) (p = 0.89). Conclusion: Trabeculectomy combined with MMC and AMT did not show better results than trabeculectomy with MMC alone.

Outcome of combined single-loop fixation of intraocular lens with Ahmed glaucoma valve implantation

“…The available modalities for management included a combination of scleral fixation of PCIOL with augmented trabeculectomy or GDD. Augmentation of trabeculectomy with mitomycin-C or amniotic membrane has been shown to increase the success rates in refractory glaucoma 7 8. Sachdev et al in a retrospective study of 22 eyes on the scleral fixated intraocular lens with Ahmed tube surgery, reported good success in terms of IOP control and vision preservation in 29.0±19.4 months follow-up 2.…”

The developments in amniotic membrane transplantation in glaucoma and vitreoretinal procedures

“…Most recently, Roque et al presented a retrospective study of 51 eyes of 45 glaucoma patients, which compared trabeculectomy with mitomycin-c application to patients who had undergone trabeculectomy with mitomycin-c and amniotic membrane. This study showed no significant difference between the two groups, however, it should be noted that this was not a randomised and controlled cohort of patients due to the retrospective nature of the study [ 52 ].…”

Novel Therapies for the Prevention of Fibrosis in Glaucoma Filtration Surgery

“…A 2015 Cochrane Review found 18 studies investigating the use of AMT with trabeculectomy. The review noted the data as low-quality but concluded that AMT can improve IOP slightly and may lead to fewer complications [ 181 ]. A systematic review of five RCTs showed that mean IOP was lower and that complications, including a flat anterior chamber and hyphema, were decreased in trabeculectomy with AMT compared to trabeculectomy without AMT [ 182 ].…”