Clinical observation of micro-invasive trabeculectomy combined with biological amniotic membrane implantation

Abstract

Objective To explore the clinical value of micro-invasive trabeculectomy combined with biological amniotic membrane implantation through reducing the surgically traumatic area.Methods In the surgeries of trabeculectomy combined with biological amniotic membrane implantation,64 eyes with glaucoma were divided randomly into 2 treatment groups.In the group of micro-invasive trabeculectomy was given to 32 eyes by making conjunctival flap measuring 4×4mm,scleral flap measuring 2.5 ×2.5mm,and resecting the trabecular meshwork measuring 1 × 1.5mm.In the group of conventional trabeculectomy was given to 32 eyes by making conjunctival flap measuring 8×8mm,scleral flap measuring 4×4mm,and resecting the trabecular meshwork measuring 1.5× 3mm.After the surgery,the changes of the intraocular pressure (IOP),the uvea,the filtering bleb and the corneal endothelium were observed and recorded.And the average follow-up duration was 12 months.Results At 12 months post-surgery,the IOP in the micro-invasive group and the conventional group were (17.36±4.25) and (15.41±6.21)mmHg,respectively.There was no significant difference between these 2 groups (P ＞0.05).There were obvious diffusing filtering blebs at the early stage post-surgery in these 2 groups.After 12 months,78.12％ (25/32) eyes of the micro-invasive group still had functional filtering blebs,while 62.5％ (20/32) eyes of the conventional group.There was no significant difference between these 2 groups (P ＞0.05).The micro-invasive group had milder uveal reaction at the early stage post-surgery than the conventional group.And the incidence of shallow anterior chamber or concomitant with choroidal detachment was higher in the conventional group,there was obvious difference between these 2 groups (P ＜0.05).At 12 months post-surgery,the loss rate of the corneal endothelium of the conventional group was 16.3％ (306.4/1880),while 9.6％ (180.5/1880) on the micro-invasive group.And there was obvious difference between these 2 groups (u =2.813,P ＜0.01).Conclusions The micro-invasive trabeculectomy combined with biological amniotic membrane implantation has good clinical effect with less operational trauma,less uveal reaction and less loss of the corneal endothelium. Key words: Glaucoma; Trabeculectomy; Micro-invasive; Amniotic membrane implantation