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Editors Selection IGR 11-1

Surgery: Amniotic membrane and buttonholes

Keith Barton

Comment by Keith Barton on:

19549 Amniotic membrane transplantation for intraoperative conjunctival repair during trabeculectomy with mitomycin C, Li G; Oʼhearn T; Yiu S et al., Journal of Glaucoma, 2007; 16: 521-526


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Li et al. (1127) have reported three cases (four eyes) in which they found amniotic membrane transplantation (AMT) to be useful in closing conjunctival buttonholes discovered at the end of surgery after trabeculectomy with Mitomycin C performed via a limbus-based conjunctival flap. In contrast with previous reports, that used single layer AMT as a replacement for conjunctival defects after glaucoma filtration surgery, the authors placed the AMT over existing conjunctiva and, in one eye, used tissue glue, rather than sutures, to secure the graft. In our previous experience, undersewing the edges of AMT below surrounding conjunctiva was found to be important to promote epithelial migration over the AMT from surrounding conjunctiva. This was especially true when there was a bleb underneath.1-4

The authors make the valid point that with small buttonholes and a wide surrounding area of tissue apposition between AMT and conjunctiva, AMT placed on top may be more than adequate to repair the buttonhole. The reported technique is potentially useful. Two foreseeable barriers to its wider use would be the requirement that AMT be routinely available in the operating department, and that patients at risk of buttonholes be accurately identified and consented for AMT before surgery, otherwise its use would not be possible.

References

  1. Barton K, Budenz DL, Khaw PT, Tseng SC. Glaucoma Filtration Surgery using Amniotic Membrane Transplantation. IOVS 2001; 42: 1762-1768.
  2. Budenz DL, Barton K, Tseng SC. Amniotic membrane transplantation for repair of leaking glaucoma filtering blebs. Am J Ophthalmol 2000; 130: 580-588.
  3. Rai P, Lauande-Pimentel R, Barton K. Amniotic membrane as an adjunct to donor sclera in the repair of exposed glaucoma drainage devices. Am J Ophthalmol 2005; 140: 1148-1152.
  4. Rauscher FM, Barton K, Budenz DL, Feuer WJ, Tseng SC. Long-term Outcomes of Amniotic Membrane Transplantation for Repair of Leaking Glaucoma Filtering Blebs. Am J Ophthalmol 2007; 143: 1052-1054.


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