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Case Reports
. 2024 Jul 22:36:102128.
doi: 10.1016/j.ajoc.2024.102128. eCollection 2024 Dec.

Amniotic membrane graft to patch an overfiltering trabeculectomy flap

Michael C Yang  1 , Michelle T Sun  1 , Wendy W Liu  1
Affiliations
Case Reports

Amniotic membrane graft to patch an overfiltering trabeculectomy flap

Michael C Yang et al. Am J Ophthalmol Case Rep. .

Abstract

Purpose: To describe the use of an amniotic membrane graft (AMG) with fibrin sealant to address an overfiltering trabeculectomy flap encountered intraoperatively.

Observations: A 35-year-old female with severe primary open angle glaucoma underwent trabeculectomy with mitomycin C due to uncontrolled intraocular pressure (IOP). Intraoperatively, the elastic nature of the scleral flap led to overfiltration, causing persistent anterior chamber shallowing despite numerous sutures. To decrease but not completely shut down aqueous outflow through the trabeculectomy flap, we utilized AMG and fibrin sealant to stabilize the flap. Postoperatively, the patient had a formed anterior chamber, elevated bleb and significantly reduced IOP, without the need for additional glaucoma medications.

Conclusions and importance: Amniotic membrane grafts (AMG) with fibrin sealant may help regulate aqueous flow efflux, maintain anterior chamber stability, and mitigate the risk of postoperative hypotony in trabeculectomy surgery. AMG was chosen in this setting given its anti-inflammatory, anti-fibrotic properties, as well as its optically clear nature to allow for post-operative visualization of the flap. AMG allows for early postoperative stabilization of the scleral flap without complete obstruction, and may be useful in patients at risk of early postoperative hypotony.

Keywords: Amniotic membrane graft; Fibrin glue; Hypotony; Overfiltering bleb; Scleral flap; Trabeculectomy.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Intraoperative images of the use of an amniotic membrane graft (AMG) to bolster an overfiltering trabeculectomy flap. A) A partial thickness scleral flap was created. B) A Kelly punch was used to create a sclerostomy followed by a surgical iridectomy. C) Despite multiple 10-0 nylon sutures, the anterior chamber remain shallow with persistent aqueous efflux through the scleral flap. D) The two components of the fibrin sealant were combined on top of the scleral flap (fibrinogen and thrombin). E) The AMG was peeled carefully from the nitrocellulose support paper F) The AMG was placed over the scleral flap (mesenchymal side down, epithelium side up). G) The conjunctiva was closed over the AMG. H) At the end of the case, the closure was Seidel negative.
Fig. 2
Fig. 2
External slit lamp image of the bleb at postoperative month one (A) and postoperative month ten (B). (A) At postoperative month one, the patient had an elevated bleb, formed anterior chamber and Seidel negative conjunctival closure. Flap sutures (arrows) were visible under the conjunctiva. (B) At postoperative month ten, the bleb was diffusely elevated.
See this image and copyright information in PMC

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