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Editors Selection IGR 12-2
Surgical treatment: Amniotic membrane
Comment by Jian Ge on:
13225 The comparison study of glaucoma trabeculectomy applying amniotic membrane or mitomycin C, Zheng K; Huang Z; Zou H et al., Eye Science, 2005; 21: 84-87
The paper by Zheng et al. (1097) compared human amniotic membrane (HAM) and MMC to prevent scar formation during filtering surgery. Scar formation is the key problem in glaucoma surgery; MMC has a number of side-effects such as hypotony, infection, macular edema, which may cause reduced visual function. HAM may have special advantages which would make it a potentially promising anti-fibrotic method in glaucoma surgery.
The authors report that the success rate of trabeculectomy with both HAM and MMC was higher than trabeculectomies without anti-fibrotics though there was no difference between the two methods. The usual complications of MMC were not seen in the HAM group except shallow anterior chamber. Although the result is quite interesting there are some limitations to this study. Firstly, the diagnosis standard of patients selected in this study should be in the same, such as: same symptom, same age, same phases of the disease. Secondly, the statistical methods used in the study (Kaplan-Meier) is not sufficient to analyze the data. Some other methods should be considered such as: linear regression analysis. Patients' data in the two groups ought to be well matched: point to point, patient to patient. Thirdly, the concentration of MMC must be kept unchanged as well as in duration of application. Finally, ethical aspects need to be considered such as information of the donor of the human amniotic membrane.
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