Use of Epimacular Amniotic Membrane Graft in Cases of Recurrent Retinal Detachment Due to Failure of Myopic Macular Hole Closure

Abstract

BACKGROUND AND OBJECTIVE: To study the anatomical and functional outcomes of using epimacular amniotic membrane graft (AMG) to close myopic macular holes (MMHs) in patients with recurrent retinal detachment (RD). PATIENTS AND METHODS: Fourteen patients with recurrent MMH-RD were enrolled in a single-arm, prospective study. Pars plana vitrectomy with peeling of any residual internal limiting membrane, preserved AMG was placed over the macular hole (MH) after air-fluid exchange, all patient left on 16% of C 2 F 6 . RESULTS: Fourteen patients (11 females and three males) with an average age of 58.7 years were included; follow-up was 6 months. Thirteen patients (93%) showed retinal reattachment and closure of the hole confirmed by optical coherent tomography. The mean logMAR of best-corrected visual acuity improved to 1.38 compared to 2.2 preoperatively ( P < .002, paired t -test), with no serious intraoperative or postoperative complications. CONCLUSION: Epimacular AMG for MMH-RD is a safe and effective treatment for closure of myopic MHs. [ Ophthalmic Surg Lasers Imaging Retina. 2020;51:101–108.]

Persistent macular holes — what is the best strategy for revision?

“…All patients underwent a transconjunctival 23-gauge pars plana vitrectomy (DORC EVA, Zuidland, Netherlands) with staining of the posterior pole (Membrane Blue Dual®, DORC, Zuidland, Netherlands) to identify ILM residues, fluid-air exchange, and internal tamponade (with instruction to posture face down in case of gas tamponade). The exact procedure including the type of tamponade (20% sulfur hexafluoride gas (SF 6 ), 15% hexafluoroethane gas (C 2 F 6 ), silicone oil 5000 (Sil 5000), or Densiron®) and the optional use of adjuvant manipulation techniques (free ILM flap translocation (f-ILM), subretinal fluid application (SRF-Appl), 6-mm epiretinal amniotic membrane [15] (EAM, AmTrix®, Horus Pharma, Saint-Laurent-du-Var, France), free retina flap (Free Retina), or application of autologous blood (AB-Appl)) were documented. The decision on which technique was used for pMH repair did not follow any specific criteria in this real-life study and was therefore at the surgeon's experience and discretion.…”

“…Hence, several adjunctive procedures have been proposed to achieve a centripetal effect for hole edge approximation and to improve bridging. These new adjuvant manipulation approaches comprise grafting techniques with free autologous ILM [7][8][9][10], centripetal hole approximation through induced macular detachment [11][12][13], an amniotic membrane [14,15], neurosensory retina from the periphery [16,17], or autologous blood products [18,19].…”

Current management strategies for atypical macular holes

“…The same technique has shown similar efficacy in managing myopic MHRD. [ 105 ] In cases of MHRD, endotamponade was either octafluoropropane (C3F8) or SO, though no difference in outcomes between these tamponade groups has been noted. [ 106 ] In one case report, hAM was also effective in closing a chronic traumatic MH that had been present for >25 years with improvement in postoperative BCVA.…”

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

“…None of these methods has yet become the gold standard. Lastly, cryopreserved human amniotic membrane (cAM), a widely available tissue, provided encouraging results e598 used either as a plug transplanted into the subretinal space (Rizzo et al 2019) (as an inlay (Letko et al 2001)), or placed in the epiretinal position (Moharram et al 2020) (as an overlay (Letko et al 2001)).…”

“…2001)), or placed in the epiretinal position (Moharram et al. 2020) (as an overlay (Letko et al. 2001)).…”