Role of triple modulation in primary trabeculectomy with Mitomycin C, amniotic membrane and releasable sutures: a pilot study

Session Details

Session Title: Glaucoma II

Session Date/Time: Tuesday 08/09/2015 | 08:00-10:30

Paper Time: 08:00

Venue: Room 17

First Author: : K.Jaisingh INDIA

Co Author(s): :    U. Yadava   S. Dangda   Y. Goel              

Abstract Details

Purpose:

To evaluate the outcome of a combined augmentation of primary glaucoma surgery with amniotic membrane transplantation (AMT), Mitomycin C (MMC) and releasable sutures.

Setting:

The study was conducted at glaucoma services of Guru Nanak Eye Centre, a tertiary eye hospital in New Delhi, India.

Methods:

40 adult primary glaucoma eyes, 35-70 years of age, posted for trabeculectomy were randomly divided into 2 equal groups. Both groups underwent trabeculectomy using 0.02% MMC for 2 minutes. Scleral flap was sutured with 3 fixed and 1 releasable suture in all cases. In addition, Amnion was placed over the scleral flap in 2nd group. Releasable suture was removed within 10 days postoperatively in all cases. Intraocular pressure (IOP) and bleb morphology was assessed monthly till 1 year, using Indiana Bleb Appearance Grading Scale (IBAGS). It was a single blind study with investigator blinded.

Results:

Both groups had significant fall in mean IOP, p˂0.00. Eyes with complete success (IOP≤16mmHg on no drugs) were significantly greater in AMT group, p=0.04. Rates of qualified success (IOP≤16mmhg with 1 drug or bleb needling) and failure (need for more than 1 drug, IOP ˃16 mm Hg or ˂6 mm Hg, additional surgical intervention, vision threatening events) were comparable, p=0.07 and p=0.15 respectively. AMT produced more number of high blebs (H2+H3) throughout (p=0.00, 0.01, 0.04 at day 1, 6 and 12 months respectively) and diffuse (E3) blebs in immediate postoperative period, p=0.03. Need for bleb needling was reduced to 1/3rd with AMT, p=0.03.

Conclusions:

AMT not just enhanced the efficacy of MMC modulated trabeculectomy but also showed a protective influence on the integrity of overlying conjunctiva. A diffusely elevated bleb with healthier conjunctiva can go a long way in predicting better health and longevity of the bleb. Releasable sutures, in addition, complemented the results by preventing postoperative shallowing of anterior chamber or immediate hypotony. Also, lesser number of complications and interventions clearly establish it as a safe and effective bleb modulator.

Financial Interest:

NONE