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.
Highlights
The failed macular hole is a full-thickness defect involving the fovea that fails to close despite 1 or more surgeries
Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling after staining with dyes, gas tamponade, and facedown positioning of the patient is the standard technique for treating a macular hole (MH), with reports of primary closure rates exceeding 90%1
Thirty-six eyes of 36 patients with failed macular hole (FMH) who had already undergone PPV with complete ILM peeling were included in this study
Summary
The failed macular hole is a full-thickness defect involving the fovea that fails to close despite 1 or more surgeries. We report postoperative outcomes on 36 patients affected by failed macular hole, treated with a human amniotic membrane plug transplant. This work demonstrates the complete anatomical success of our technique, and remarkable functional results, and opens the door to a greater understanding of modifications induced by the presence of a human amniotic membrane plug. Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling after staining with dyes, gas tamponade, and facedown positioning of the patient is the standard technique for treating a macular hole (MH), with reports of primary closure rates exceeding 90%1. While many surgical options have been proposed, none of these guarantee complete anatomical success and satisfactory visual recovery; these alternative techniques are often burdened by limits related to the technical complexity of execution, the need for 2 surgical times, or the need for tissues that are not always readily available
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