Epiretinal large disc of blue‐stained lyophilized amniotic membrane to treat complex macular holes: a 1‐year follow‐up

Abstract

Purpose: To report the long-term outcomes of large diameter epiretinal lyophilized amniotic membranes (lAMs) in recurrent or persistent macular holes (MHs) with or without rhegmatogenous retinal detachment (RRD), in a prospective interventional case series. Methods: Ten eyes of 10 patients underwent pars plana vitrectomy for MH-associated RRD (n = 5) or persistent MH without RRD (n = 5), in a university Hospital. A 3 or 4 mm diameter disc of lAM, stained with 0.06% trypan blue, was inserted with a catheter through a sclerotomy and positioned over the MH. Gas or silicone-oil tamponade was used. At 1 year, the main outcome was anatomic success defined as complete MH closure. Secondary outcomes were best corrected visual acuity (BCVA) recovery, changes in ellipsoid zone (EZ) and external limiting membrane (ELM) defects, complications. Mean follow-up was 13.8 AE 2.9 months (range, 12-18). Results: Mean baseline data were minimum and maximum diameters, respectively, 945 AE 330 and 1507 AE 717 lm; axial length 26.58 AE 3.38 mm; and number of prior surgeries 1.4 AE 0.96. At 1 year, anatomic success was achieved in eight eyes (80%), and two had reduced diameter of MH. All RRDs were reattached without recurrence. Mean logMAR BCVA improved from 1.92 AE 0.58 to 1.17 AE 0.57 (p < 0.001), with nine eyes (90%) achieving ≥0.3 logMAR improvement. Mean EZ and ELM defects decreased (p = 0.004, p = 0.003, respectively). Postoperative complications were RRD (n = 1) reattached by subsequent surgery, lAM slightly retracted under silicone (n = 1), foveal atrophy after early lAM displacement (n = 1). Conclusion: A 1-year follow-up highlighted that epiretinal large discs of bluestained lAM can help safely close refractory MHs, and provide satisfactory visual recovery.

Epiretinal implant of human amniotic membrane to treat highly myopic macular hole retinal detachments: A novel surgical technique

“…12 Then, Garcin et al described the use of large diameter epiretinal lyophilized hAM in a cohort of 10 patients with recurrent or persistent macular holes associated or not with retinal detachment, reporting satisfactory visual recovery at one year. 13 Moreover, Qiao et al reported an improvement in visual acuity in almost 90% of patients treated with an epiretinal hAM patch for MHRD in highly myopic patients following failed primary surgery. 14 Epiretinal implant of the hAM plug could be technically easier compared to subretinal implant and could present less possible intraoperative complications, such as plug dislocation within the subretinal space during the fluid-air exchange or during the subretinal fluid drainage.…”

“…Furthermore, in our opinion, crucial differences are relevant in the present surgical technique compared to the previous abovementioned studies of hAM epiretinal implants. 12,13,14 Creating a retinotomy could represent a substantial improvement. Instead of draining through the macular hole as performed by Moharram et al, indeed, a retinotomy allows the aspiration of the subretinal fluid in a less traumatic way, avoiding the risk of enlarging the macular hole or inadvertently touching the subfoveal RPE.…”

“…Recent studies reported the epiretinal implant of different types of hAM in cases of recurrent myopic macular holes associated with retinal detachment achieving good results in terms of safety and visual outcome. 12,13,14 The aim of the present study is to describe a new surgical technique involving the use of a hAM epiretinal patch to treat a primary MHRD in a highly myopic patient.…”

“…Recent studies reported the epiretinal implant of different types of hAM in cases of recurrent myopic macular holes associated with retinal detachment achieving good results in terms of safety and visual outcome. 12,13,14…”

The developments in amniotic membrane transplantation in glaucoma and vitreoretinal procedures

“…Recent publications have noted the use of amniotic membrane transplant in conjunction with vitrectomy for the treatment of macular holes [69][70][71]. Studies in vivo and in vitro have shown that AM transplantation can promote the regeneration of retinal tissue when placed under the fovea [72][73][74].…”