Glaucoma filtration surgery using amniotic membrane transplantation.

PURPOSE To investigate the potential use of amniotic membrane transplantation (AMT) in the construction of glaucoma filtering blebs. METHODS Twenty-four albino rabbits underwent glaucoma filtration surgery in one eye. In alternate cases, the conjunctival flap was replaced with AMT. Postoperative examination data were grouped into three time points. Six animals with AMT and six filtration surgery-controls were euthanatized at each of two postoperative time points, and tissue was obtained for histologic examination. Conjunctival biopsies were explanted for estimation of fibroblast outgrowth. RESULTS Bleb formation was observed in all eyes, and amniotic membranes were epithelialized after 11.2 +/- 2.48 (mean +/- SD) days. Throughout the study IOPs were significantly lower in operated than unoperated fellow eyes. Between postoperative days 11 and 16 (the middle time point), the percentage IOP reduction in AMT eyes was significantly greater than in filtration surgery controls (P = 0.014), though not at other time points. Filtration surgery survival was significantly longer in the AMT group (22.3 +/- 3.8 days; mean +/- SE) than in "No AMT" controls (14.0 +/- 1.6 days; P = 0.035). In tissue culture, significantly less fibroblast outgrowth occurred from AMT explants when compared with unoperated conjunctiva (P = 0.01) between postoperative days 3 and 9 (the early time point). Amniotic membrane transplants were intact on histologic examination after 14 days but were associated with considerable granulomatous inflammation. After 36 days, the ocular surfaces remained clinically intact, but lysis of AMT was noted histologically. CONCLUSIONS AMT exhibits potential as an alternative tissue to conjunctiva in the construction of glaucoma filtration blebs. The healing response as demonstrated by fibroblast outgrowth is retarded when compared with conventional conjunctival closure. The improvement in bleb survival must be weighed against the potential for complications related to delayed healing. In rabbits, human amniotic membrane elicited a late xenograft reaction, leading to granulomatous inflammation and dissolution of the membrane.

[1]  S. Tseng,et al.  Amniotic membrane transplantation for repair of leaking glaucoma filtering blebs. , 2000, American journal of ophthalmology.

[2]  S. Tseng,et al.  Amniotic membrane transplantation for severe neurotrophic corneal ulcers , 2000, The British journal of ophthalmology.

[3]  S. Tseng,et al.  Suppression of TGF-ß signaling in both normal conjunctival fibroblasts and pterygial body fibroblasts by amniotic membrane , 2000 .

[4]  S. Tseng,et al.  Suppression of TGF-beta signaling in both normal conjunctival fibroblasts and pterygial body fibroblasts by amniotic membrane. , 2000, Current eye research.

[5]  F. Kruse,et al.  Multilayer amniotic membrane transplantation for reconstruction of deep corneal ulcers. , 1999, Ophthalmology.

[6]  D. Budenz,et al.  Conjunctival advancement for late-onset filtering bleb leaks: indications and outcomes. , 1999, Archives of ophthalmology.

[7]  S. Tseng,et al.  Suppression of transforming growth factor‐beta isoforms, TGF‐β receptor type II, and myofibroblast differentiation in cultured human corneal and limbal fibroblasts by amniotic membrane matrix , 1999 .

[8]  S. Tseng,et al.  Conjunctival epithelial cell differentiation on amniotic membrane. , 1999, Investigative ophthalmology & visual science.

[9]  S. Tseng,et al.  Amniotic membrane transplantation with or without limbal allografts for corneal surface reconstruction in patients with limbal stem cell deficiency. , 1998, Archives of ophthalmology.

[10]  S. Tseng,et al.  Amniotic membrane transplantation for conjunctival surface reconstruction. , 1997, American journal of ophthalmology.

[11]  P. Khaw,et al.  Effect of varying the mitomycin-C treatment area in glaucoma filtration surgery in the rabbit. , 1997, Investigative ophthalmology & visual science.

[12]  S. Tseng,et al.  Comparison of conjunctival autografts, amniotic membrane grafts, and primary closure for pterygium excision. , 1997, Ophthalmology.

[13]  S. Tseng,et al.  Amniotic membrane transplantation for persistent epithelial defects with ulceration. , 1997, American journal of ophthalmology.

[14]  D. Budenz,et al.  Trabeculectomy with intraoperative 5-fluorouracil vs mitomycin C. , 1997, American journal of ophthalmology.

[15]  D. Minckler,et al.  "Late endophthalmitis"--filtering surgery time bomb? , 1996, Ophthalmology.

[16]  H. Flynn,et al.  Endophthalmitis after filtering surgery with mitomycin. , 1996, Archives of ophthalmology.

[17]  K. Tsubota,et al.  Surgical reconstruction of the ocular surface in advanced ocular cicatricial pemphigoid and Stevens-Johnson syndrome. , 1996, American journal of ophthalmology.

[18]  P. Lichter,et al.  Bleb-related endophthalmitis after trabeculectomy with mitomycin C. , 1996, Ophthalmology.

[19]  Five-year follow-up of the Fluorouracil Filtering Surgery Study. The Fluorouracil Filtering Surgery Study Group. , 1996, American journal of ophthalmology.

[20]  R. D'Amato,et al.  Angiogenesis inhibition in age-related macular degeneration. , 1995, Ophthalmology.

[21]  S. Tseng,et al.  Transplantation of Preserved Human Amniotic Membrane for Surface Reconstruction in Severely Damaged Rabbit Corneas , 1995, Cornea.

[22]  J. G. Ford,et al.  Central visual field changes associated with acquired pits of the optic nerve. , 1995, Ophthalmology.

[23]  P. Lichter,et al.  Mitomycin C versus 5-fluorouracil in high-risk glaucoma filtering surgery. Extended follow-up. , 1995, Ophthalmology.

[24]  H. Grossniklaus,et al.  Histopathologic effects of mitomycin C after trabeculectomy in human glaucomatous eyes with persistent hypotony. , 1994, American journal of ophthalmology.

[25]  A. Hutchinson,et al.  Clinicopathologic features of excised mitomycin filtering blebs. , 1994, Archives of ophthalmology.

[26]  M. B. Shields,et al.  Clinical and histopathologic observations concerning hypotony after trabeculectomy with adjunctive mitomycin C. , 1993, American journal of ophthalmology.

[27]  K. Singh,et al.  A prospective trial of intraoperative fluorouracil during trabeculectomy in a black population. , 1993, American journal of ophthalmology.

[28]  M. F. Smith,et al.  Intraoperative 5-fluorouracil for filtration surgery in the rabbit. , 1993, Investigative ophthalmology & visual science.

[29]  J. Schuman,et al.  Ocular hypotony after trabeculectomy with mitomycin C. , 1993, American journal of ophthalmology.

[30]  A. Mermoud,et al.  Trabeculectomy with mitomycin C for refractory glaucoma in blacks. , 1993, American journal of ophthalmology.

[31]  R. Stamper,et al.  Long-term effects of mitomycin on filtering blebs. Lack of fibrovascular proliferative response following severe inflammation. , 1993, Archives of ophthalmology.

[32]  J. M. Ortiz,et al.  Hypotonous maculopathy after trabeculectomy with subconjunctival 5-fluorouracil. , 1993, American journal of ophthalmology.

[33]  P. Khaw,et al.  Prolonged localized tissue effects from 5-minute exposures to fluorouracil and mitomycin C. , 1993, Archives of ophthalmology.

[34]  M. F. Smith,et al.  Results of intraoperative 5-fluorouracil supplementation on trabeculectomy for open-angle glaucoma. , 1992, American journal of ophthalmology.

[35]  A. Ophir,et al.  A randomized study of trabeculectomy and subconjunctival administration of fluorouracil in primary glaucomas. , 1992, Archives of ophthalmology.

[36]  J. C. Jones,et al.  The role of the basement membrane in differential expression of keratin proteins in epithelial cells. , 1992, Developmental biology.

[37]  P. Lichter,et al.  Intraoperative mitomycin versus postoperative 5-fluorouracil in high-risk glaucoma filtering surgery. , 1992, Ophthalmology.

[38]  R. Ritch,et al.  Initial 5-fluorouracil trabeculectomy in young patients. , 1992, Ophthalmology.

[39]  L. Clearkin,et al.  Complications of 5-fluorouracil after trabeculectomy , 1992, Eye.

[40]  Y. Kitazawa,et al.  Trabeculectomy with mitomycin. A comparative study with fluorouracil. , 1991, Archives of ophthalmology.

[41]  R. Ritch,et al.  Late bleb-related endophthalmitis after trabeculectomy with adjunctive 5-fluorouracil. , 1991, Ophthalmology.

[42]  W. Steinmann,et al.  Use of trabeculectomy with postoperative 5-fluorouracil in patients requiring extremely low intraocular pressure levels to limit further glaucoma progression. , 1991, Ophthalmology.

[43]  R. Ritch,et al.  Initial 5-fluorouracil trabeculectomy in uncomplicated glaucoma. , 1991, Ophthalmology.

[44]  S. Palmer,et al.  Mitomycin as adjunct chemotherapy with trabeculectomy. , 1991, Ophthalmology.

[45]  C. W. Chen,et al.  Trabeculectomy with simultaneous topical application of mitomycin-C in refractory glaucoma. , 1990, Journal of ocular pharmacology.

[46]  R. Hitchings,et al.  Wound healing in an animal model of glaucoma fistulizing surgery in the rabbit. , 1989, Ophthalmic surgery.

[47]  R. Parrish,et al.  Wound healing in glaucoma filtering surgery. , 1987, Survey of ophthalmology.

[48]  M. Gressel,et al.  Glaucoma filtering surgery with 5-fluorouracil. , 1987, Ophthalmology.

[49]  C. W. Chen.  ENHANCED INTRAOCULAR PRESSURE CONTROLLING EFFECTIVENESS OF TRABECULECTOMY BY LOCAL APPLICATION OF MITOMYCIN C , 1983 .

[50]  J. Trelford,et al.  The amnion in surgery, past and present. , 1979, American journal of obstetrics and gynecology.

[51]  R. Reba,et al.  Permeability of different layers of the human placenta to isotopic water. , 1969, Journal of applied physiology.

[52]  Maumenee Ae,et al.  External filtering operations for glaucoma: the mechanism of function and failure. , 1960 .

[53]  A. E. Maumenee,et al.  External filtering operations for glaucoma: the mechanism of function and failure. , 1960, Transactions of the American Ophthalmological Society.