A human amniotic membrane plug to repair retinal detachment associated with large macular tear

Abstract

Purpose: To describe a surgical technique, using a human amniotic membrane (hAM) plug, in two cases of retinal detachment with a large macular tear. Methods: Surgical technique description with surgical video. A 23-gauge pars plana vitrectomy with peripheral retinectomy was performed. An hAM plug was implanted under the neuroretina to seal the posterior retinal break. Standard silicone oil tamponade was performed at the end of the surgery. The patients were positioned face down after the operation for the first 2 weeks. Optical coherence tomography (OCT) scans were performed in the follow-ups. Results: The 1 week postoperative OCT showed a neuroretina ingrowth over the hAM plug. The 3-month OCT showed a regenerated neurosensory retina entirely covering the hAM plug. Visual acuity improved from light perception to 20/400 (LogMAR 1,3) 3 months after the operation in both patients. The silicone oil was extracted 4 months after surgery, and no recurrences were observed. The patients' visual acuity remained stable at 20/400 after the silicone oil extraction. Conclusion: In these complex cases, hAM transplantation can be a valid option not only to help the retinal reattachment but also for a partial regenerative effect which, in these cases, was accompanied by a visual acuity recovery.

<p>Amniotic Membrane Transplantation in Ophthalmology: An Updated Perspective</p>

“…Amnion plugs can be implanted in the subretinal space with the chorion layer facing the RPE in an attempt to close 171 presented a case series of two eyes of two patients with retinal detachment and large macular tears. Pars plana vitrectomy was performed in conjunction with an AMT, and standard silicone oil tamponade.…”

“…At three months, both patients' optical coherence tomography showed neuroretinal ingrowth over the amniotic membrane plug. 171 The use of amnion in vitreoretinal surgery is a novel and innovative technique that requires greater understanding and research but certainly appears encouraging.…”

Human amniotic membrane plug to promote failed macular hole closure

“…The use of the human amniotic membrane (hAM) patch to close 8 recurrent macular holes was already proposed by Rizzo et al in 2018 7 ; the anatomical success was 100% with a mid-term follow-up (6 months after surgery) and 20% sulfur hexafluoride (SF 6 ) used as the endotamponade in all cases. The use of the hAM plug has also been proven to be effective in repairing retinal breaks 7 , large macular tears associated with retinal detachment 8 , and high-myopic macular holes associated with retinal detachment 9 .…”

Applications of the Amniotic Membrane in Vitreoretinal Surgery

“…The hAM application for retinal pathologies was extended to treat large macular tears [ 31 ], high myopic retinal detachment associated with MH [ 32 ], paravascular tears [ 33 ], serous macular detachment associated with optic pits [ 34 ], complicated retinal detachment [ 30 ] and advanced age related macular degeneration (AMD) [ 35 ].…”