The Application Of Finished-product Amniotic Membrane And Anterior Lens Capsule In Phacotrabeculectomy

Objectives1. To evaluate the efficacy of finished-product amniotic membrane and anterior lens capsule implantation in phacoemulsification combined with trabeculectomy in rabbits’eyes.2. To compare the clinical outcomes of finished-product amniotic membrane with anterior lens capsule applied in phacotrabeculectomy and evaluate the safety and effectiveness of the finished-product amniotic membrane and anterior lens capsule.Methods1. Animal experiment:Twenty-four New Zealand white rabbits were randomly divided into groupA,B and C; each group was consisting of8rabbits (8eyes). The finished-product amniotic membrane and anterior lens capsule were respectively implanted under the scleral flap in phacoemulsification combined with trabeculectomy in group A and group B, while only phacoemulsification combined with trabeculectomy in group C. The anterior chamber inflammation reation and type of filtering bleb were observed under the slitlamp, intraocular pressure (IOP) was measured at postoperative1day,7days,14days,28days, and pathological changes in filter corridor were also observed under the photon microscope.2. Clinical research:Sixty patients with coexisting cataract and uncontrolled glaucoma were performed by two site phacotrabeculectomy and at the end of the surgery the removed anterior lens capsule was placed under the scleral flap in group ALC and finished-product amniotic membrane in group FPAM. Postoperative evaluations included IOP, BCVA, type of the filtering bleb and complication were conducted on the months1,3,6and12.UBM and visual field examination were performed regular. All the data were analyzed by the SPSS16.0statistical soft ware package.Results1. The postoperative IOP in group A, B and C decreased obviously,there were statistical differences among the three group at postoperative7days,14days,21days (P＜0.05). While compared group A with group B, finished-producted amniotic membrane could effectively depress IOP, which at postoperative7days,14days,21days in group A were (7.17±0.22) mmHg (1kPa=7.5mmHg),(7.54±0.47) mmHg and(11.81±0.74) mmHg, in group B were (7.79±0.16) mmHg,(8.76±0.81)mmHg (14.03±0.25) mmHg, there were statistical differences between two group(all P＜0.05). While anterior chamber inflammation reaction and filtering bleb type at postoperative lday,7days,14days,21days among group A, B and C, group A and B had action and filtering bleb type at postoperative1day,7days,14days,21days among group A, B and C, group A and group B had more functional filtering bleb and serious anterior chamber inflammation reaction, but the difference was not statistically significant (P>0.05). Histopathology examination showed that the passage of humor outflow kept open at early stage after surgery in all groups. The maintenance of functional filtering bleb associated with implants. At postoperative28days,the passage of humor outflow opened completely in group A and B,and there were less fibroblasts in group A, but few inflammatory cells infiltrated, the edge of anterior lens capsule became dull,there were still no lymphocytes in group B, the filtering trace was completely blocked by the scar tissue in group C.2. Clinical research:In group ALC the preoperative IOP improved from23.00±5.92mmHg to13.57±3.26mmHg. In group FPAM, the IOP improved from22.60±5.84mmHg to12.27±2.26mmHg. There was statistically significant difference (tALC=5.011, P＜0.05; tFPAM=6.581, P＜0.05). The degree of IOP drop between two groups was no statistically difference at each time point. Comparison of the BCVA between preoperative and postoperative1year revealed a significant improvement in both the groups (tALC=-11.411, P＜0.05; tFPAM=-15.337, P＜0.05). There was no statistical difference between the ALC and the FPAM groups in the formation of functional filtering blebs (x2=0.297, P＞0.05) on postoperative1year. The success rate of the surgery was86.2%(25/29) in group ALC and90.3%(28/31) in group FPAM, there was no statistically significant difference between both the groups (x2=0.246, P＞0.05). The mean number of eye drops used preoperatively was2.45in group ALC and2.39in group FPAM. The mean number of eye drops used on postoperative1year was0.14in group ALC and0.096in group FPAM. There was statistically significant difference between preoperation and postoperation (tALC=13.970, tMMC=14.772, P＜0.05). The postoperative complications between two groups resolved or eased in two weeks after operation, there was no rejection in group ALC ang group FPAM. The visual field was stable on postoperative1year compared with preoperative. The filtration intervals were clear on postoperative3month of all patients, anterior lens capsule and finished-product amniotic membrane were found in some ones in group ALC and group FPAM, the FPAM partly dissolved.Conclusions1. Application of finished-product amniotic membrane and anterior lens capsule in phacotrabeculectomy may safely and effectively depress IOP, inhibit or relieve the growth of fibroblasts, and improve the success rate of surgery.2. Finished-product amniotic membrane used in combined surgery of glaucoma and cataract could get comparable outcome as anterior lens capsule in decrease IOP effectively, improve VA and sustain visual field. The FPAM and ALC is safe and effective.