| Objective: This study was designed to determine whether theautotransplantation of human anterior lens capsule in the trabeculectomy site can aidfiltration.Methods: 1 experimental study: Eight New Zealand white rabbits were used inthis experiment. One eye of every rabbit was randomly assigned to undergophacoemulsification + trabeculectomy + anterior lens capsule autotransplantation, theother received phacoemulsification + trabeculectomy to serve as control. Thepresence of filtering bleb, intraocular pressure and clinical manifestation wereevaluated at the different time-points post-operatively. Each group of two rabbitswere sacrificed and the eyes were enucleated on day 1,7,14,28. After the eyes werefixed by 10％formalin, serial paraffin sections of two eyes were labeled with HEstaining and the pathological morphology was observed under a microscope. 2clinical pilot study: 46 patients with coexisting cataract and uncontrolled glaucomadespite maximum medical therapy were enrolled in this study. In the experimentalgroup, combined phacoemulsification, posterior chamber intraocular lensimplantation, and trabeculectomy were performed in 29 eyes of 25 patients, theanterior lens capsule was then put under the scleral flap. In the control group,phacoemulsification, posterior chamber intraocular lens implantation, andtrabeculectomy were performed in 21 eyes of 21 patients, antimetabolites were used intraoperative. Follow-up period was 6 months. The outcome parameters evaluatedwere appearance of the filtering bleb, ultrasound biomicroscopy (UBM), intraocularpressure, best corrected visual acuity and optic disc shape. 3 cell culture study: Thespecimens of human anterior lens capsule were obtained from patients withcoexisting cataract and glaucoma. Each capsule was cut into two pieces and culturedin flasks. In the experimental group, the capsule was scraped before culture to removethe lens epithelial cells.Results: 1 experimental study: The period of intraocular pressure decrease ineyes of the experimental group (3 weeks) were longer than that in eyes of the controlgroup (2 weeks). The fibroblastic proliferation of filtering pathway and scarformation were found at 2 weeks post-operation in eyes of the experimental group,and that were found at 4 weeks after surgery in eyes of the control group. Tissuecompliance was good and no elimination occurred. 2 clinical pilot study: (1) Therewas no statistical difference in the formation of functional filtering blebs between theexperimental group(24/29) and the control group(19/21) (x~2=0.132, P＞0.05). (2) In 6months postoperatively, intraocular pressure in the experimental group significantlydecreased from 23.1 (SD 8.2) mm Hg before surgery to 13.4 (3.5) mm Hg after (t=7.093, P＜0.01). And intraocular pressure in the control group significantlydecreased from 23.4(SD 7.7) mm Hg before surgery to 13.1 (2.8) mm Hg after (t=7.308, P＜0.01). There was no difference between the intraocular pressure of thetwo groups (t=0.342, P＞0.05). (3) The median number of anti-glaucoma medicationsreduced from 2 preoperatively to 0 at the last postoperative visit in both groups(Z=-4.623, -3.983; P＜0.01, 0.01). And there was no difference between the two groups(Z = -0.800, P＞0.05). (4)There was no obviously difference in best corrected visualacuity between the two groups at 6 months postoperatively (x~2 = 0.055, P＞0.05). (5) The anterior lens capsule could be detected in the filtering site by using ultrasoundbiomicroscopy 1 month after surgery in the experimental group. (6) Optic discparameters remained unchanged or became better in the experimental group. (7) Nospecial side effect was noted. 3 cell culture study: in the control group human lensepithelial cells grew out of the edge of tissue pieces after incubation for 48～72 hours.They maintained typical epithelial morphology and reached confluence after 2～3weeks. In the experimental group, no cell was found around the lens capsule.Conclusions: These results suggested that the use of lens capsule inphacotrabeculectomy can effectively lower the intraocular pressure and reduce thesorts of anti-glaucoma medications, with the unchanged visual acuity. Thepostoperative complications were few. The anterior lens capsule was cheap and easyto obtain. Therefore, it is very hopeful and practicable in trabeculectomy.
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