Effectiveness and Safety of Trabeculectomy along with Amniotic Membrane Transplantation on Glaucoma: A Systematic Review

Abstract

Purpose. To determine the effectiveness and safety of trabeculectomy along with amniotic membrane transplantation (AMT) for glaucoma. Methods. This systematic review was performed using RevMan 5.3. We searched PubMed, EMBASE, and the Cochrane Library and included studies published until September 2019. The treatment group included patients with AMT and trabeculectomy (group A), and the control group had only trabeculectomy (group B). We only included randomized controlled trials. The outcomes were intraocular pressure (IOP), complete success rate, number of antiglaucoma medications, and complications. Results. Five studies, including 174 eyes (87 eyes in the AMT group and 87 eyes in the control group), were eligible in this review. The parameters had no significant difference in heterogeneity between the AMT and control groups preoperatively. In the AMT group, the mean IOP was significantly lower at 3 and 12 months after operation (P < 0.0001 and P = 0.02, respectively), while the number of complete successes in the AMT group was significantly higher at 6 and 12 months (P = 0.02 and P = 0.003, respectively) compared with the control group. Complications, including a flat anterior chamber and hyphema, appeared to be decreased in the AMT group compared to the control group (P = 0.02 and P = 0.02, respectively). No differences were observed in the number of antiglaucoma medications, hypotony, encapsulated bleb, or choroidal detachment. Conclusion. Compared with only trabeculectomy, it is more efficient and safer to add AMT to trabeculectomy during glaucoma filtering surgery.

The Effect of Amniotic Membrane Transplantation on Trabeculectomy in Patients with Pseudoexfoliation Glaucoma

“…These results are consistent with the results of earlier studies which reported that concomitant AMT under the scleral flap and/or over the sclera, with or without MMC, improved the surgical outcome of trabeculectomy [ 22 , 23 , 25 – 27 , 41 , 42 ]. A randomized trial found that the IOP-lowering effect of AMT-assisted trabeculectomy without MMC was comparable to trabeculectomy with MMC over 2 years and suggested the amniotic membrane as a potential alternative [ 43 ].…”

The developments in amniotic membrane transplantation in glaucoma and vitreoretinal procedures

“…Some studies report the placement of the AM below of scleral flap in a 'inlay-graft' fashion [48,49], however, other studies state that the tissue is placed over the wound in an 'onlay-graft' fashion to over the entire exposed scleral bed [32,44,50]. As a whole, data shows the application of AM epithelial-side-down [2] when placed onto the wound. Although these differences are present, no obvious differences have been noted regarding outcomes dependent on surgical technique.…”

“…Following this, Shen et al [2] ran a meta-analysis of randomised controlled clinical trials that assess the AM assisted trabeculectomy to trabeculectomy alone. Shen et al's meta-analysis included 174 eyes across 5 studies, the data noted that there was a statistically significant benefit in the intraocular pressure of patients in the AM treatment group at 3 months ( p < 0.0003 ) and 12 months ( p = 0.02 ).…”

“…Therefore, AM has a potential to improve the success rate and lower the complications rate of trabeculectomies with mitomycin-c even further [2].…”

“…The results of these studies suggest that AM transplant is a safe procedure that helps in the improvement of the intraocular pressure when associated with trabeculectomies. Moreover, it enhances trabeculectomies success rates when used along with mitomycin C [2]. The use of AM is also described for managing leaking blebs.…”