[Shunt tube implantation combining amniotic membrane transplantation and implantation of Molteno implant for glaucoma after penetrating keratoplasty].
OBJECTIVE
To investigate the therapeutic effect of aqueous humor shunt implants with amniotic membrane transplantation on intractable glaucoma.


METHODS
Glaucoma was induced in rabbits by the injection of alpha-chymotrypsin into the posterior chamber of the eyes. The rabbits were divided into four groups. Group A: control group, Group B: single shunt tube group, Group C: shunt tube with amniotic membrane transplantation group, Group D: shunt tube with amniotic supporter and amniotic membrane transplantation group. The intraocular pressure(IOP), histology and filterable ability of the tissue around the tubes were studied. The therapeutic effect of the three methods for the glaucoma was compared. From 1998 to 1999, 42 eyes of 41 patients with uncontrolled glacoma after penetrating keratoplasty were randomly assigned into two groups. One group (12 eyes) underwent implantation of shunt tube combining transplantation of amniotic membrane. The other group underwent implantation of a single plate Molteno implant. Clinical records were reviewed to ascertain postoperative IOP, visual acuities, number of medications.


RESULTS
The IOP elevated after the operation and reached at the peak on the third day for all groups and then dropped slowly. The IOP was 33.34 +/- 5.54 mmHg (1 mmHg = 0.133 kPa) for Group A and 27.88 +/- 8.86 mmHg for Group B three months after the operation. There was no statistical difference between the two groups (P = 0.274). The IOP was 22.33 +/- 3.73 mmHg for Group C and there was statistical significant difference between Group C and Group A (P = 0.02) and no difference between Group C and Group B (P = 0.113). The IOP was 15.74 +/- 2.94 mmHg for Group D and there was statistical significant difference between Group D and Group A (P = 0.001) and Group B (P = 0.036). There was no difference between Group D and Group C (P = 0.09). The study of horseradish peroxidase penetrability indicated that there was peroxidase in the tissues around the tube with amniotic membrane transplantation and no peroxidase for simple shunt tube. The fibrous tissue near the tube was denser in simple shunt tube group than that in containing amnion groups. In clinic, the basic data existed no statistical difference between the two groups before surgery. The IOP was 54.42 +/- 9.65 mmHg in shunt tube with amnion group and 43.28 +/- 10.57 mmHg in simple plate Molteno implant group (P = 0.535) before operation. There was significant relativity of the visual acuity before and after the operation in two groups (r = 0.916, P = 0.002 and r = 0.962, P = 0.000). Most patients of the two groups had to use one or two anti glaucoma drugs. The overall success rates were 58.3% for shunt tube with amnion group and 66.7% for Molteno implant group (P = 0.73) within the follow-up period. Kaplan-Meier success analysis indicated one year cumulative success rates of 52.25% for shunt tube with amnion group and of 65.3% for Molteno implant group (P = 0.42).


CONCLUSIONS
Amniotic membrane can inhibit proliferation of the scar around the shunt tube. Shunt tube implantation conbining amniotic membrane transplantation can significantly lowered the IOP of glaucoma. Combined using amnion supporter can expend shunt area and significantly reduce IOP of glaucoma. The effect of shunt tube implantation combining amniotic membrane transplantation has the similar result of single plate Molteno implant for the glaucoma after penetrating keratoplasty.
Liu
Y
Y
Zhongshan Ophthalmic Center, Sun Yat-sen University of Medical Sciences, Guangzhou 510060, China.
Li
H
H
Chen
J
J
D000328:Adult; D000650:Amnion / Q000637:transplantation*; D000818:Animals; D002918:Chymotrypsin; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000139:chemically induced / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018465:Molteno Implants; D011817:Rabbits; D011897:Random Allocation; D014792:Visual Acuity
D002918:Chymotrypsin