Abstract
BackgroundThe 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.MethodsRetrospective 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.ResultsNineteen 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.ConclusionThe 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.
Highlights
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
Following the pathogenetic theory described by Gass [3], Kelly and Wendel reported in 1991 the successful closure of an macular holes (MH) in 30 of 52 (58%) patients with MHs using vitrectomy and gas [4]
Based on the evaluation of this data, the authors proposed that an measurement of the minimum linear diameter (MH MLD) of < 650 μm could be used as an optimal “inflection marker” to predict when MHs are more likely to close with standard surgery [12]
Summary
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. Eckhart et al [6] and Park et al [7] reported that the MH closure rate could be improved by adding internal limiting membrane (ILM) peeling delamination to the surgical procedure. There is epidemiologic data supporting the use of MH MLD as a guide for surgical selection in patients with MHs. In the Manchester Large Macular Hole Study, the anatomical success rate of type 1 closure (closed without foveal neurosensory retinal defect) of full thickness macular holes (FTMH) with “standard” ILM peeling delamination varies from 91% (59/65) to 98% (64/65) in MHs between 400–649 μm in MLD, and 76% (49/64) in those from 650–1416 μm MLD. The use of the amniotic membrane transplantation to treat ocular surface abnormalities was first reported seven decades ago [26] In these cases, hAM works as an optimal biological support for conjunctival cell growth. No retina or vitreous inflammation was noted in this study
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