Human amniotic membrane plug to promote failed macular hole closure

Abstract

The failed macular hole is a full-thickness defect involving the fovea that fails to close despite 1 or more surgeries. While many surgical options have been proposed to manage it, none of these guarantee complete anatomical success and satisfactory visual recovery. We report postoperative outcomes on 36 patients affected by failed macular hole, treated with a human amniotic membrane plug transplant. Follow-ups were performed with a standard ophthalmological examination and with advanced multimodal diagnostic imaging. Anatomical closure was achieved at 3 months in all patients. Mean best-corrected visual acuity improved statistically significantly at 6 months (p < 0.05). Through microperimetric tests, we assessed a partial recovery of the macular sensitivity on the edges of the plug. Analyzing SD-OCT images, we reported a tissutal ingrowth above the plug, and its segmentation into layers, mimicking normal retinal architecture. OCT-Angiography images non invasively analysed the retinal parafoveal capillary microvasculature; the elaboration of Adaptive Optics images showed the presence of photoreceptors at the edges of the plug. This work demonstrates not only the complete anatomical success of our technique, but also remarkable functional results, and opens the door to a greater understanding of modifications induced by the presence of a human amniotic membrane plug.

Surgical Management of Recurrent and Persistent Macular Holes: A Practical Approach

“…The mean minimum MH diameter was 779.8 ± 142.53 lm in the SF6 group and 799 ± 175.18 lm in the air group. Similar success rates have been reported in additional case series with the use of hAM for MH closure, though studies comparing this technique to others have not been published [74][75][76].…”

Human amniotic membrane for the treatment of large and refractory macular holes: a retrospective, multicentric, interventional study

“…The treatment of recurrent macular holes is still a challenge for a retinal surgeon. Caporossi et al [ 31 ] described an anatomical and functional success of the use of hAM at failed macular hole. The failure rate of primary surgery in idiopathic macular holes is less than 10%.…”

“…have limitations in reoperation or LMH due to initial wide ILM peel, excessive manipulation of the macular hole edges, difficulty in obtaining the harvested ILM tissue for an autologous flap in the periphery, especially in high myopes, dislocation of the ILM flap, impossibility to use the lens capsule in pseudophakic eyes with an open posterior capsule, intraoperative risks of perforation and subretinal hemorrhage, and the long-term risks of compression of the macula from the macular buckle, prolapse to fat, extrusion, and strabismus in macular buckling and scleral imbrication techniques. Some authors have described retinal fibrosis and pigment epithelium dystrophy in the macular area, after internal limiting membrane autologous transplantation for recurrent macular hole, which can affect final visual recovery [ 31 ]. The OCT analysis on our patients pre and post-operative did not show these pathological findings, however, it is still unclear in the literature how long it takes for the membrane to disappear and the neural tissue to re-proliferate the hole.…”

Anatomical and Functional Outcomes of Relaxing Parafoveal Nasal Retinotomy for Refractory Macular Hole Repair

“…1,10 Despite current advances in primary repair procedures, postoperative outcomes for large MHs (aperture diameter > 400 mm) are suboptimal compared with smaller defects, 11 and achieving long-term closure in persistent or recurrent MHs remains a surgical challenge. Several procedures involving inverted ILM flap techniques, autologous ILM transplant, lens capsular flap transplant, MH hydrodissection, autologous neurosensory retinal transplant, and human amniotic membrane plugs have been developed to promote the closure of large or refractory MHs [12][13][14][15][16][17] ; however, a consensus surgical approach has not yet been established.…”