Amniotic membrane transplantation for repair of leaking glaucoma filteringblebs

PURPOSE: To compare the safety and efficacy of human preserved amniotic mem brane transplant with conjunctival advancement for repair of late-onset gla ucoma filtering bleb leaks. METHOD: A prospective, randomized clinical trial com pared amniotic membran e transplant with conjunctival advancement in patients with leaking glaucom a filtering blebs, Intraocular pressure, number of glaucoma medications, an d reoperation for glaucoma or persistent or recurrent bleb-leak were compar ed in the two groups, Patients were followed for a minimum of 1 year. RESULTS: Mean intraocular pressure was the same at 6 (amniotic membrane tra nsplant, 15.4 +/- 4,4, conjuncti val advancement 14.1 +/- 6,4, P = 0.6), 12 (amniotic membrane transplant, 15.0 +/- 6.3, conjunctival advancement, 13. 2 +/- 6.6, P = 0.5), and 24 (amniotic membrane transplant, 17.2 +/- 7.1, co njunctival advancement, 15.0 +/- 6.3, P = 0.6) months, The mean number of g laucoma medications in use was the same in the two groups at all time inter vals. After an average follow-up of 19 months, there were seven failures in the amniotic membrane transplant group (two with persistent leaks that wer e unresponsive to further suturing, two with late-onset leaks, and three wh o required repeat glaucoma surgery) and none in the conjunctival advancemen t group, The cumulative survival rate for amniotic membrane transplant was 81% at 6 months, 74% at 1 year, and 46% at 2 years. The cumulative survival rate was 100% for conjunctival advancement throughout follow-up. CONCLUSIONS: Amniotic membrane transplantation does not offer an effective alternative to conjunctival advancement for repair of leaking glaucoma filt ering blebs. (C) 2000 by Elsevier Science Inc. All rights reserved.