Simultaneous Use of Amniotic Membrane and Mitomycin C in Trabeculectomy for Primary Glaucoma: A Pilot Study

Abstract

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.