Lyophilized amniotic membrane insignificantly reduces postoperative adhesions and fibrosis, when used to wrap the operated upon extraocular muscles, limiting the benefit of this membrane in strabismus surgery.

. Purpose:  To histopathologically evaluate the effect of cryopreserved human amniotic membrane (AM) transplant on preventing the development of postoperative adhesions after extraocular muscle surgery. Methods:  Ten albino rabbits were used. The superior rectus muscles were bilaterally resected. In right eyes, the muscle was wrapped with cryopreserved human AM (group AM). In left eyes, the muscle was not wrapped with AM and served as a control group (group C). The rabbits were killed, and the eyes were enucleated 6 weeks after surgery to perform histopathological examination. Results:  On histopathological examination, the AM was present in eight eyes, surrounded by periamniotic inflammation, with no adhesions detected between rectus muscle and sclera, conjunctiva and Tenon’s capsule in the segment where the AM was present, but detected elsewhere. Adhesions were detected in the other two eyes of group AM, in which the AM was absent, and in all group C eyes. When comparing eye pairs of each rabbit, AM eyes showed significantly less adhesions between the muscle and sclera (p = 0.009) and between the muscle and Tenon’s capsule and conjunctiva (p = 0.008), in the region of AM application, and significantly more foreign body inflammation (p = 0.031), than C eyes. The differences between AM and C eye pairs, in terms of conjunctival inflammation and vascularity and muscle fibrosis, were insignificant (p > 0.05). Conclusions:  Cryopreserved AM is effective in reducing postoperative extraocular muscle adhesions. Its application is, therefore, recommended during strabismus reoperations.

Various techniques have been used to reduce adhesions after strabismus surgery. Wrapping the extraocular muscles with cryopreserved amniotic membrane has been reported to yield good results. In the case reported here, we used lyophilized amniotic membrane to wrap the extraocular muscles. Extensive adhesions developed, and inelastic, fibrotic muscles were discovered at a subsequent operation.

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ABSTRACT.Purpose: The aim of this study was to assess the efficacy of viscotrabeculotomy in the management of congenital glaucoma as compared to conventional trabeculotomy, in Egyptian infants. Methods: This is a prospective interventional randomized comparative study in which patients with primary congenital glaucoma were randomly allocated to either group A or B; viscotrabeculotomy (VT); and trabeculotomy (T), respectively. Patients were followed up regarding intra-ocular pressure (IOP), cup/disc (C/D) ratio and horizontal corneal diameter (HCD) for 6 months. A probability value (p value) <0.05 was considered significant. Results: Twenty-one eyes in group A and 20 eyes in group B were enrolled in the study. The mean preoperative IOP was 23.5 and 24.3 mmHg in the VT and T groups, respectively. Postoperatively, IOP dropped at six months to 14.7 and 17 mmHg in the VT and T groups, respectively. That was significant in either group when compared to preoperative IOP, but not significant between both groups at the same point of comparison. Conclusions: Both techniques were equally effective in the reduction in IOP in the management of congenital glaucoma, but viscotrabeculotomy did not appear to add more benefit to the surgical outcome than classic trabeculotomy.

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