Simultaneous Use of Amniotic Membrane and Mitomycin C in Trabeculectomy for Primary Glaucoma: A Pilot Study
2016
Purpose: Role of amniotic membrane transplantation as an additional modulator in primary Mitomycin C
augmented trabeculectomy.
Design: Randomised prospective interventional study.
Methods: 40 eyes of 39 adult patients with uncontrolled primary glaucoma were randomly divided into 2 equal
groups. Control group underwent trabeculectomy augmented with Mitomycin C while the study group underwent
additional amniotic membrane transplantation. Patients were followed up for 12 months and outcomes measured
were Intraocular Pressure, need for additional intervention and bleb morphology.
Results: Complete success (defined as intraocular pressure <16 mmHg on no medication) could be achieved in
85% eyes in study group while it was 60% in control group (p=0.04). Intraocular pressure reduced by 71.1% in study
group from 41.9 ± 10.6 mmHg to 12.1±2.7 mm Hg and from 40.5 ± 8.5 mmHg to 12.8 ± 4.5 mmHg in control group,
a decline of 68.29%.
Blebs in amniotic membrane transplantation group showed better bleb morphology in terms of significantly better
extent (E3) on day 1 (p=0.03) and better height (H2 and H3) (p=0.04), according to Indiana Bleb Appearance
Grading Scale, at all follow up visits along with normal vascularity. The study group required significantly lesser
(p=0.03) bleb needlings as compared to control group.
Conclusion: Amnion enhanced the efficacy of Mitomycin C modulated trabeculectomy in terms of eyes with
complete success and lesser interventions like bleb needling. This reiterates the role of amnion as a safe and
effective bleb modulator. A diffusely elevated bleb with healthier conjunctiva can go a long way in predicting better
health and longevity of the bleb.
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