Use of amniotic membrane as an adjuvant in refractory glaucoma

To evaluate the results after amnion-shielded trabeculectomy with concomitant use of mitomycin C.

The study comprised patients with severely refractory glaucomas who had previously undergone two or more regular trabeculectomies with mitomycin C and, in one case, cyclodestructive cryotherapy. The patients were admitted for surgery between May 2003 and May 2004. Trabeculectomy was performed through a limbus-based incision in nine eyes of nine patients. Cryopreserved human amniotic membranes obtained from our biobank were impregnated with 0.4 mg/ml mitomycin C and washed for 2 mins in balanced salt solution. One membrane was sutured to the scleral surface and partly positioned under the scleral flap, and another was secured to subconjunctival tissue.

The mean preoperative intraocular pressure (IOP) was 32.2 mmHg (range 22-44 mmHg). After a follow-up of 6-18 months (mean 9.8 months), the mean IOP was 16.4 mmHg (range 11-26 mmHg). The mean number of glaucoma medications was reduced from 2.4 preoperatively to 1.4 postoperatively. There were no devastating complications.

Amnion-shielded trabeculectomy is a procedure that should be evaluated as an option in refractory glaucoma.