Amniotic membrane-assisted trabeculectomy for refractory glaucoma with corneal disorders

Figures & data

Figure 1 Images illustrating the new AM-assisted TLE procedure.

Notes: (A) First, conventional TLE with a limbus-based conjunctival flap and a 3-minute mitomycin C (0.4 mg/mL) treatment were performed. (B) AM, trimmed to the proper size, was then placed on the corneal surface with the epithelial side up. This was followed by suturing at the limbal sclera beside the scleral flap with 10-0 nylon sutures. (C) The other edge of the AM was then flipped over to cover the scleral flap. (D) Finally, a continuous conjunctival suturing with 10-0 polypropylene around the AM was performed. (E) A cross-sectional view of the filtering bleb with the AM patch.
Abbreviations: AM, amniotic membrane; TLE, trabeculectomy.

Table 1 Summary of the six cases of patients with refractory glaucoma and severe corneal disorders

Case	Age at op,years	Sex	Glaucomatype	Reason of corneal disorder	Previous op	BCVA preop (logMAR)	Gla med pre op (drugs)	IOP preop (mmHg)	BCVA last visit (logMAR)	Gla med last visit (drugs)	IOP last visit (mmHg)	Follow-up period (months)
1	50	M	SG	Chem injury	PKP + PEA + IOL lensectomy	1.5	4	37	2.8	0	20	33
2	58	M	SG	Injury	TLE, PKP 2 bleb revision	2.7	4	34	2.9	0	8	94
3	58	F	SG	Injury infection	PKP TLE	2.4	1	48	2.7	2	38	96
4	82	F	PACG SG	APAC several op infection	ECCE + IOL IOL extraction PKP	2.8	3	44	2.9	0	6	68
5	85	M	PEG	Drug-induced OCP	TLO	2.7	3	47	2.8	2	28	110
6	84	F	SG PEG	LI cataract op infection	PKP PPV + PEA + IOL	0.5	3	32	2.7	1	13	76

Notes: logMAR visual acuity; hand motion: 2.7, light perception (+): 2.8, and light perception (−): 2.9.

Abbreviations: op, operation; preop, preoperative; IOP, intraocular pressure; M, male; SG, secondary glaucoma; chem, chemical; PKP, penetrating keratoplasty; TLE, trabeculectomy; F, female; PACG, primary angle closure glaucoma; ECCE, extracapsular cataract extraction; PEG, pseudoexfoliation glaucoma; OCP, ocular cicatricial pemphigoid; TLO, trabeculotomy; LI, laser iridotomy; PPV, pars plana vitrectomy; logMAR, logarithm of minimal angle of resolution; PEA, phaco emulcification aspiration; IOL, intra ocular lens; APAC, acute primary angle closure; Gla med, glaucoma medications; BCVA, best corrected visual acuity.

Figure 2 Images of three representative cases.

Notes: (A–C) Filtering blebs post AM-assisted TLE in all three patients. (D) Optical coherence tomography image (sagittal view) of the filtering bleb in case 1 at 2 years postoperative.
Abbreviations: AM, amniotic membrane; TLE, trabeculectomy.

Figure 3 Time course of IOP changes in all six cases.

Abbreviation: IOP, intraocular pressure.