Use of amniotic membrane as an adjuvant in refractory glaucoma

Purpose: To evaluate the results after amnion-shielded trabeculectomy with concomitant use of mitomycin C. Methods: 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. Cryo-preserved 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. Results: 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. Conclusions: Amnion-shielded trabeculectomy is a procedure that should be evaluated as an option in refractory glaucoma.