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A prospective study of combined phacotrabeculectomy with and without amniotic membrane

Session Details

Session Title: Glaucoma

Session Date/Time: Monday 07/10/2013 | 17:00-18:34

Paper Time: 17:16

Venue: Elicium 2 (First Floor)

First Author: : A.Ganguly INDIA

Co Author(s): :    J. Sengupta              

Abstract Details

Purpose:

This study was conducted to evaluate the outcome of Phacotrabeculectomy with and without amniotic membrane in terms of long term pressure control and bleb structure.

Setting:

Priyamvada Birla Aravind Eye Hospital, Kolkata. India

Methods:

in this prospective randomised comparative study 40 eyes of 40 patients were divided into 2 groups of 20 each. The first group underwent Phacotrabeculectomy with amniotic membrane and the second group underwent standard Phaco trabeculectomy. All surgeries were performed by a single surgeon.

Results:

Patients were evaluated for bleb charecteristics (IBAGS)and intra ocular pressures. The patients were followed up for a two year period by a single investigator. Mean pre operative IOP in the study group was 25.85 mm of Hg(95%CI-19.90-31.80;Median-23; Range 14 to 68) and in the control group was 33.2 mm of Hg (95%CI-27.79-38.61;Median-32.5;Range-14to60.) Paired ‘t’ test comparing the pre operative IOP in the two groups yielded a P value of 0.0502, which was not significant. The mean IOP at 24 months was 13.89 mm of Hg in the study group (CI-12.37-15.98;Range8–20)and 22.35 mm of Hg in the control group (CI-18.24-26.47;Range12–48).Comparing the 24 months follow up final IOP in the two groups by the paired t test yielded a `p’ value of 0.0009 which was statistically significant. In the study group we had 14 good blebs (out of 18) where as in the control group we had 8 good blebs (out of 17)(Paired t test-two tailed `p’ value – 0.0858-not significant). In the study group there were 3 failures and in the control group there were 8 failures according to the criteria set by us. Statistical analysis showed an absolute risk reduction of 30.39% and the NNT was 4.

Conclusions:

Despite the fact that bleb architecture was not significantly better in the study group, the IOP at 24 months between the two groups reached statistically significant difference. The conclusions in our study were that Phacotrabeculectomy with amniotic membrane promotes lower postoperative IOP as compared with conventional Phaco trabeculectomy. But a large randomized surgical clinical trial comparing AM trabeculectomies and standard trabeculectomies would be ideally indicated in this scenario to settle the issue.

Financial Interest:

NONE