Evaluation of sub-tenon mitomycin-c trabeculectomy with amniotic membrane transplantation in glaucoma: a single arm prospective study

Abstract

Background: Long term success of trabeculectomy is largely depende nt on modulation of postoperative wound healing. Conventional sponge-applied mitomycin-C (MMC), although effective, is associated with variability in dosing and bleb-related complications. Sub-tenon MMC injection and amniotic membrane transplantation (AMT) have emerged as adjuncts aimed at improving bleb quality and surgical safety. Aim: To evaluate the efficacy and safety of trabeculectomy augmented with sub-tenon MMC and amniotic membrane transplantation in patients with glaucoma. Materials and Methods: This prospective interventional study include d 21 patients with medically uncontrolled primary open-angle or primary angle-closure glaucoma.All patients underwent trabeculectomy with standardized sub-tenon MMC injection followed by placement of cryopreserved amniotic membrane over the scleral flap. Pre- and postoperative intraocular pressure (IOP), anti-glaucoma medication requirement, bleb morphology, complications, and surgical outcomes were assessed during follow-up. Results: The majority of patients were above 50 years of age with a slight male predominance. Primary open-angle glaucoma was the most common type (76.2%). Mean IOP decreased from 28.4 ± 4.6 mmHg preoperatively to 14.2 ± 2.8 mmHg at 1 month and 13.6 ± 2.4 mmHg at 3 months postoperatively. Postoperatively, 71.4% of patients required no antiglaucoma medications. Diffuse functioning blebs were observed in 76.2% of eyes. Postoperative complications were minimal. Complete surgical success was achieved in 66.7% of patients, while qualified success was observed in 23.8%. Conclusion: Sub-tenon MMC-augmented trabeculectomy combined with AMT provides effective IOP control, favorable bleb morphology, and a low complication profile, representing a promising surgical approach in glaucoma management.