Abstract
To describe a combined surgical technique utilizing the Macular Hole Hydrodissection (MHH) with human amniotic membrane (hAM) for repair of large macular holes. A step-by-step procedure and a surgical video using the combined MHH and hAM technique are presented. As the first step, the MHH separates the adhesions of the macular hole to the underlying retinal pigment epithelium (RPE) with a soft tipped cannula through proportional reflux followed by gentle passive aspiration. The hAM graft is marked to identify the non-sticky epithelial side and ensure that the stromal layer (sticky and non-shinny) is facing downward towards the RPE. The graft is then tucked into the space created with MHH between the macular hole edges and the RPE with closed forceps to decrease the likelihood of the graft from dislocating post-operatively. The MHH in combination with the hAM is a practical and effective technique for addressing challenging large macular holes.
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