title: Amniotic membrane transplantation in failed trabeculectomy.
abstract: OBJECTIVE
  To determine the efficacy and safety of amniotic membrane transplantation for trabeculectomy in patients with previous failed filtering blebs.
  
  
  METHODS
  A consecutive series of 19 eyes from 18 patients with 1 or more failed trabeculectomies were enrolled in this retrospective study. Trabeculectomy, with amniotic membrane positioned as a "graft" under the scleral flap, was performed, and the intraocular pressure (IOP), number of antiglaucoma medications, appearance of the filtering bleb, and intraoperative and postoperative complication data were retrospectively analyzed for a period of 24 months. Success was defined as IOP<21 mm Hg at the end of the follow-up period.
  
  
  RESULTS
  The median preoperative pressure was 29 mm Hg [interquartile range (IQR)=5 mm Hg], with an average of 2.8 glaucoma medications (range, 1 to 4). At 6 months postoperatively the median IOP was 18 mm Hg (IQR=1.75 mm Hg) with no further significant increases recorded, settling at 19 mm Hg (IQR=3.25 mm Hg) at the end of the 24-month follow-up. Success was achieved in all 19 cases (100%), and only 1 patient (5%) required postoperative antiglaucoma therapy to reach the target pressure. At 24 months after surgery, 18 of 19 (95%) amniotic membrane filtering blebs were functioning well without antiglaucoma therapy. No patients had severe intraoperative or postoperative complications.
  
  
  CONCLUSIONS
  Amniotic membrane transplantation in trabeculectomy seems to be a safe and useful procedure for improving the surgical outcome and maintaining low postoperative IOP in patients with a high risk of surgical failure.
authors.affiliation: *Department of Ophthalmology, Misericordia Hospital, Grosseto †Department of Ophthalmology, University of Siena, Siena ‡DICeM, Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio-Italy, Cassino, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Sarnicola
authors.forename: Chiara
authors.initials: C
authors.lastname: Millacci
authors.forename: Patricia
authors.initials: P
authors.lastname: Toro Ibanez
authors.forename: Caterina
authors.initials: C
authors.lastname: Sarnicola
authors.forename: Enrica
authors.initials: E
authors.lastname: Sarnicola
authors.forename: Andrew
authors.initials: A
authors.lastname: Ruggiero
mesh_terms: D000368:Aged; D000650:Amnion / Q000637:transplantation*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D017211:Treatment Failure