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.

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A Human Amniotic Membrane Plug to Promote Retinal Breaks Repair and Recurrent Macular Hole Closure

Retina ◽

10.1097/iae.0000000000002320 ◽

2019 ◽

Vol 39 ◽

pp. S95-S103 ◽

Cited By ~ 38

Author(s):

Stanislao Rizzo ◽

Tomaso Caporossi ◽

Ruggero Tartaro ◽

Lucia Finocchio ◽

Fabrizio Franco ◽

...

Keyword(s):

Macular Hole ◽

Amniotic Membrane ◽

Human Amniotic Membrane ◽

Retinal Breaks ◽

Hole Closure

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A Human Amniotic Membrane Plug to Treat Persistent Macular Hole

Case Reports in Ophthalmology ◽

10.1159/000509339 ◽

2020 ◽

Vol 11 (2) ◽

pp. 442-447

Author(s):

Luca Ventre ◽

Paola Marolo ◽

Michele Reibaldi

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Amniotic Membrane ◽

Functional Results ◽

Human Amniotic Membrane ◽

Corrected Visual Acuity ◽

Macular Holes ◽

Critical Issues ◽

Pars Plana

The human amniotic membrane (hAM) has lately demonstrated interesting potential in its retinal applications. Nowadays, the treatment of persistent macular holes is still a challenge. In this paper, we present a case of a hAM plug used to treat a persistent macular hole, with the purpose of highlighting the critical issues of this new surgical procedure. We performed a 23-G pars plana vitrectomy and inserted a hAM plug (diameter of 1.5 mm) under the neuroretinal margins of the hole (diameter of 657 μm). A complete ophthalmic examination with the assessment of best-corrected visual acuity (logMAR units, ETDRS letter score) and optical coherence tomography (OCT) scans were collected at 1, 4, 6, and 10 weeks after surgery. Visual acuity changed from logMAR 1.0 (1) preoperatively to logMAR 1.0 (2), 1.0 (4), 0.9 (9), and 0.9 (10) at 1, 4, 6, and 10 weeks of follow-up, respectively. The 1 week postoperative OCT did not show neuroretinal adhesion over the plug, but the following visits showed reattachment of the margins with partial neuroretinal ingrowth. These findings suggest that the correct adaptation of the size of the hAM plug to the macular hole is essential to allow the anatomical closure of the hole and potential functional results.

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Novel method of plugging the hole: Anatomical and functional outcomes of human amniotic membrane-assisted macular hole surgery

Journal of Current Ophthalmology ◽

10.4103/joco.joco_189_20 ◽

2020 ◽

Vol 32 (4) ◽

pp. 361

Author(s):

Ramesh Venkatesh ◽

NareshKumar Yadav ◽

Sherina Thomas ◽

Arpitha Pereira ◽

KBhujang Shetty

Keyword(s):

Macular Hole ◽

Amniotic Membrane ◽

Functional Outcomes ◽

Human Amniotic Membrane ◽

Macular Hole Surgery ◽

Novel Method

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Human amniotic membrane for failed macular hole. A case of initial unsuccessful outcome that resolved after amniotic membrane exchange

European Journal of Ophthalmology ◽

10.1177/11206721211058996 ◽

2021 ◽

pp. 112067212110589

Author(s):

Tomaso Caporossi ◽

Lorenzo Governatori ◽

Tommaso Verdina ◽

Stanislao Rizzo

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Amniotic Membrane ◽

Sulfur Hexafluoride ◽

Silicone Oil ◽

Human Amniotic Membrane ◽

Second Surgery ◽

Myopic Macular Hole ◽

Oil Injection ◽

Membrane Patch

Introduction We described a case of initial unsuccessful outcome of failed macular hole treated with amniotic membrane, that resolved after amniotic membrane exchange and silicone oil injection. Case Description a woman affected by a high myopic macular hole that had failed to close after multiple surgeries, had been treated using an amniotic membrane graft and 20% sulfur hexafluoride but, after the gas reabsorption, the macular hole was still open, and the amniotic membrane. A second surgery with a second amniotic membrane patch and silicone oil was carried out. Two weeks after the procedure the macular hole closed, and the final visual acuity improved from 20/400 to 20/100. Conclusions In this case, a second surgery, using a new amniotic membrane graft and a longer-lasting endotamponade, closed the hole and improved the visual acuity.

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Amniotic Membrane Plug to Promote ChronicPost-Traumatic Macular Hole Closure

Ophthalmic Surgery Lasers and Imaging Retina ◽

10.3928/23258160-20191211-07 ◽

2019 ◽

Vol 51 (1) ◽

pp. 50-52 ◽

Cited By ~ 4

Author(s):

Tomaso Caporossi ◽

Bianca Pacini ◽

Lorenzo De Angelis ◽

Stanislao Rizzo

Keyword(s):

Macular Hole ◽

Amniotic Membrane ◽

Hole Closure

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Comparative analysis of macular microstructure in eyes treated with human amniotic membrane plug or internal limiting membrane transplant for Failed Macular Hole

Acta Ophthalmologica ◽

10.1111/aos.15013 ◽

2021 ◽

Author(s):

Bianca Pacini ◽

Daniela Bacherini ◽

Alfonso Savastano ◽

Stanislao Rizzo ◽

Tomaso Caporossi

Keyword(s):

Comparative Analysis ◽

Macular Hole ◽

Amniotic Membrane ◽

Internal Limiting Membrane ◽

Human Amniotic Membrane

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Parafoveal atrophy after human amniotic membrane graft for macular hole in patients with high myopia

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-315603 ◽

2020 ◽

pp. bjophthalmol-2019-315603

Author(s):

Der-Chong Tsai ◽

Yu-Hsuan Huang ◽

Shih-Jen Chen

Keyword(s):

Macular Hole ◽

Amniotic Membrane ◽

Axial Length ◽

High Myopia ◽

Rare Complication ◽

Case Series ◽

Visual Outcome ◽

Human Amniotic Membrane ◽

Significant Difference

PurposeTo report the surgical outcome and postoperative hypopigmented change around fovea among patients with high myopia who received human amniotic membrane (hAM) graft transplantation for macular hole (MH).MethodThis retrospective, interventional case series included 10 eyes of 10 consecutive patients (5 (50%) male) with high myopia (axial length over 26.5 mm) who received hAM graft to treat persisted or chronic MH with or without retinal detachment in two hospitals. Postoperative parafoveal atrophy was identified with colour fundus picture and structure optical coherent tomography. Baseline characteristics and short-term visual outcome were analysed.ResultsThe preoperative mean (±SD) axial length and MH diameter were 29.9 (±1.8) mm and 881.8 (±438.5) μm, respectively. After hAM transplantation, seven (70%) eyes had complete MH closure and the mean best-corrected visual acuity (BCVA) improved from 1.26 (±0.48) logarithm of minimal angle of resolution (logMAR) before operation to 1.11 (±0.44) logMAR on the last visit (p=0.074). Patchy atrophy-like depigmentation developed around the MH lesion in four (40.0%) eyes as early as in the first month after surgery. None of them had visual worsening. In terms of demographics, axial length, MH size, ocular history, preoperative BCVA and postoperative BCVA, there was no significant difference between those with and without the parafoveal atrophy. No graft rejection and inflammation happened during the follow-up.ConclusionParafovea atrophy, a rare complication in the conventional MH surgery, was observed in 40% of eyes with highly myopic MH after hAM graft transplantation. The pathogenesis and long-term consequence need further investigations.

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

Ophthalmic Surgery Lasers and Imaging Retina ◽

10.3928/23258160-20200129-06 ◽

2020 ◽

Vol 51 (2) ◽

pp. 101-108 ◽

Cited By ~ 1

Author(s):

Hossam M. Moharram ◽

M. Tarek Moustafa ◽

Hassan A. Mortada ◽

Mohamed Farouk Abdelkader

Keyword(s):

Retinal Detachment ◽

Macular Hole ◽

Amniotic Membrane ◽

Myopic Macular Hole ◽

Hole Closure

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

International Journal of Retina and Vitreous ◽

10.1186/s40942-021-00308-6 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Magno A. Ferreira ◽

André Maia ◽

André J. Machado ◽

Raquel E. A. Ferreira ◽

Luiz Felipe Hagemann ◽

...

Keyword(s):

Amniotic Membrane ◽

Retrospective Chart Review ◽

Functional Results ◽

Internal Limiting Membrane ◽

Human Amniotic Membrane ◽

Off Label ◽

Macular Holes ◽

Wilcoxon Rank Sum Test ◽

Snellen Chart

Abstract Background The purpose of the current study is to report the anatomical and functional results of off-label human amniotic membrane graft as primary intervention to repair large to giant macular holes and in reoperations when wide internal limiting membrane peeling was unsuccessful. Methods Retrospective chart review was carried out in five different centers to identify all cases that had undergone off-label human amniotic membrane graft for the treatment of large or failed macular holes (MH). Data collected included age, gender, other concomitant diagnosis, symptoms duration, lens status, number of previous surgeries, macular hole measurements (minimum and base linear diameters), mean post-operative follow-up (months), and pre- and post-operative best corrected visual acuity (BCVA). Main outcome measures were anatomical MH closure rates and final BCVA (in logMAR). Nonparametric Wilcoxon rank-sum test was used because the data was not normally distributed, a P values < 0.05 were considered statistically significant. Results Nineteen eyes of 19 patients were identified and included in the study. Mean age was 66.21 ± 14.96 years and predominantly females (84%). All eyes had successfully closed MH with a single intervention with no recurrences during a mean of 9 ± 3.87 months follow-up. The median BCVA in logMAR preoperative was 1.30 ± 0.44 (0.80–2.0), approximately 20/400 on Snellen chart and the median BCVA in logMAR postoperative was 1.0 ± 0.72 (0.4–3.0) approximately 20/200 (p < 0.0001) with median of three lines of visual improvement. Conclusion The use of human amniotic membrane graft seems to be a viable and effective alternative for the treatment of large and persistent macular holes. However, further larger prospective controlled studies are necessary to confirm our preliminary results of this new surgical technique.

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