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

Abstract

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 $\ge$ 20% and (2) IOP ≤15 mmHg and IOP reduction $\ge$ 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 $P\le 0.047$ ). 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).