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

Purpose: The aim is to evaluate the effect of amniotic membrane transplantation (AMT) on trabeculectomy with mitomycin C in patients with pseudoexfoliation glaucoma (PXG).

Methods: This retrospective cohort study included 85 eyes of PXG who underwent trabeculectomy with or without AMT (52/33 eyes in the AMT/control group). Surgical success was defined by these criteria: (1) intraocular pressure (IOP) ≤18 mmHg and IOP reduction ≥20% and (2) IOP ≤15 mmHg and IOP reduction ≥25%. Criteria A and B defined complete success rates as patients who met these criteria without medication, respectively. Criteria C and D defined qualified success rates as patients who met these criteria with medication, respectively. Cumulative probabilities of success were compared using the Kaplan-Meier survival analysis. Cox proportional hazard models were used to evaluate the influence of AMT on surgical success accounting for confounding variables.

Results: For the AMT group, compared with the control group, the complete success rates at 12 months for criterion A were 86.5% and 63.6%, respectively ( P = 0.017) and for criterion B, 86.4% and 63.6% ( P = 0.005). The qualified success rates at 12 months for criterion C were 92.1% and 75.1%, respectively ( P = 0.047) and for criterion D, 92.1% and 72.1% ( P = 0.021). On multivariable Cox regression analyses, AMT was associated with a lower failure rate on criteria A, B, and D (all P ≤ 0.047). Incidence of avascular bleb was higher in the control group than in the AMT group (7 vs 0 eyes; P = 0.004).

Conclusions: In patients with PXG, trabeculectomy with AMT was associated with higher success rates and a lower incidence of avascular bleb compared with conventional trabeculectomy. Research Registration . This retrospective cohort study was registered at the Clinical Trial Registry of Korea (https://cris.nih.go.kr/cris/index/index.do, KCT0007228).