Comparison between Cryopreserved and Dehydrated Human Amniotic Membrane Graft in Treating Challenging Cases with Macular Hole and Macular Hole Retinal Detachment.

Yu-Hsuan Huang,Der-Chong Tsai,Lei-Chi Wang,Shih-Jen Chen

doi:10.1155/2020/9157518

Abstract

Purpose To evaluate the surgical outcomes of cryopreserved and dehydrated human amniotic membrane (hAM) graft transplantation for macular hole (MH) and macular hole retinal detachment (MHRD) repair. Materials and Methods This retrospective, interventional case series was conducted in two hospitals. Two types of hAM grafts, namely, the dehydrated form (AmnioGen, HCT Regenerative, Taiwan) and the cryopreserved form (AmnioGraft, Bio-Tissue, Miami, FL), were consecutively used in MH surgeries. Anatomical and functional outcomes between the 2 types of hAM grafts were compared. Results Seventeen patients (mean age: 62.1 ± 10.0 years, 9 (52.9%) males) were enrolled. Of them, 11 patients had persistent MH, 3 had MH without prior surgery, and 3 had MHRD. A cryopreserved hAM graft was used in 10 patients, and a dehydrated hAM graft was used in 8 patients. One patient used a cryopreserved hAM in the first MH surgery and a dehydrated hAM in the second surgery for extramacular hole with retinal detachment. After a 6-month follow-up, 13 (76.5%) patients had sealed MHs. The average visual acuity (VA) of cases with sealed MHs improved from 1.38 ± 0.62 to 1.12 ± 0.47 logMAR (p=0.03). In the other 4 cases with persistent MH, 3 had graft dislocation and 1 had a reopened MH with graft contraction. There were no significant differences in closure rate (80.00% vs. 71.43%, p=0.68) or VA improvement (0.19 ± 0.37 logMAR vs. 0.15 ± 0.41 logMAR, p=0.85) between the 2 kinds of hAM graft. Conclusion This preliminary case series showed that both cryopreserved hAM and dehydrated hAM are feasible alternative grafts for either persistent or recurrent MH. Both approaches have similar anatomical and functional outcomes.

Highlights

Human amniotic membrane grafts have been widely applied in the treatment of ocular surface disorders for a long time, as they serve as a scaffold for cell growth and migration, facilitate re-epithelialization by providing growth factors, and reduce inflammation and scarring by inhibiting TGF-β signal transduction [14,15,16,17]
We aimed to report the surgical outcomes of applying cryopreserved or dehydrated Human amniotic membrane (hAM) graft transplantation for persistent MH, recurrent macular hole retinal detachment (MHRD), or primary MH and MHRD with macular holes larger than 500 μm
No marked regression in either graft type was noted in this short-term follow-up. In this short case series, we found no significant differences in the anatomical or functional outcomes between the two types of hAM graft

Summary

Introduction

Persistent macular holes (MHs) and macular hole retinal detachment (MHRD) or primary MHs and MHRD with large holes are very challenging to manage and often cause severe visual impairment, especially in highly myopic eyes [1,2,3,4]. e reported rates of persistence and reopening of MHs are 4.8%– 9.2% in previous studies where surgeons had used different materials such as internal limiting membranes, lens capsules, and autologous retinal free-flaps to fill the hole [5,6,7,8,9,10,11,12,13].Human amniotic membrane (hAM) grafts have been widely applied in the treatment of ocular surface disorders for a long time, as they serve as a scaffold for cell growth and migration, facilitate re-epithelialization by providing growth factors, and reduce inflammation and scarring by inhibiting TGF-β signal transduction [14,15,16,17]. Two types of commercial hAM graft products are available for medical use: cryopreserved and dehydrated amniotic membranes. Ey differ in morphology and structure due to differences in processing [21] Both types of commercial hAM graft have been utilized in plastic and orthopedic surgery, such as for burns [22], diabetic foot ulcers [23, 24], tendinopathy, and arthritis [25, 26]. We aimed to report the surgical outcomes of applying cryopreserved or dehydrated hAM graft transplantation for persistent MH, recurrent MHRD, or primary MH and MHRD with macular holes larger than 500 μm

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Conclusion