Internal Limiting Membrane Peeling Research Articles

Macular atrophy following macular hole surgery assisted by Membrane Blue-Dual: A case series.

The aim of this study is to describe the clinical and multimodal imaging findings in patients with macular atrophy following macular hole surgery assisted by Membrane Blue Dual. This study is a monocenter, retrospective, observational case series that included patients who presented macular atrophy following macular hole surgery. Among the patients included in this study, four were operated for idiopathic macular hole and one for total retinal detachment associated with macular hole. In all patients the internal limiting membrane was brittle and adherent and multiple stains were required. One month postoperatively all patients showed a reduced visual acuity excepted the patient with total retinal detachment. At fundus examination all patients showed patchy atrophy with a mottled hypo- and hyperpigmented appearance in the macular region. Optical coherence tomography scans demonstrated a closed macular hole with retinal thinning, disruption of the external retinal layers and irregular retinal pigment epithelium thickening. Fundus autofluorescence showed a well-defined area of both hypo- and hyper-autofluorescence involving the macular area. Macular atrophy following Membrane Blue Dual assisted internal limiting membrane peeling represents a severe complication that vitreoretinal surgeons should be aware of and that should be taken into account in preoperative evaluation and surgical procedure planning. In order to reduce the risk of this complication, we recommend to ensure the best conditions of visibility, to reduce as much as possible the intensity and the distance of the endoillumination from the retina, and to use as little dye as possible.

Comparison of outcomes of idiopathic macular holes treated by vitrectomy with air or silicone oil tamponade based on the hole size.

To compare the efficacy of vitrectomy combined with air or silicone oil in the treatment of idiopathic macular hole (IMH). According to the results of high-definition optical coherence tomography (HD-OCT), 75 cases (75 eyes) of IMH in stage II-IV (Gass stage) in the General Hospital of Chinese PLA from January 2017 to December 2019 were collected for this retrospective study. The best corrected visual acuity (BCVA) and minimum diameter of IMH (MMHD) were measured. Eyes underwent vitrectomy combined with internal limiting membrane peeling operation, and were divided into disinfection air group (30 eyes) and silicone oil group (45 eyes) according to the intraocular tamponade. For MMHD≤400 µm (MMHD1), there were 23 eyes in air group and 16 eyes in silicone oil group. For MMHD2>400 µm (MMHD2), there were 7 eyes in air group and 29 eyes in silicone oil group. One month after surgery, the closure rates of IMH and BCVA were compared and analyzed. According to HD-OCT, the closure shape was graded with A (bridge closure) and B (good closure). The closure rates of air group and silicone oil group were 86.67% and 95.56% respectively with no significant difference (P>0.05); For MMHD1, those of air group and silicone oil group were 95.65% and 100% respectively with no significant difference (P>0.05); For MMHD2, those of air group and silicone oil group were 57.14% and 93.10% respectively, and those of the silicone oil group were higher than the air group (P<0.05). There was no significant difference in the closure shape grade between MMHD1 air group and silicone oil group (P>0.05). The proportion of Grade B in MMHD2 silicone oil group was higher than that in the air group (P<0.05). BCVA of each group after operation was better than that before operation, and there was no significant difference between air group and silicone oil group. While among them, MMHD1 air group was better than silicone oil group (P<0.05), and there was no significant difference between MMHD2 air group and silicone oil group (P>0.05). For smaller IMH (≤400 µm), the efficacy of vitrectomy combined with air should be considered better than silicone oil; for larger IMH (>400 µm), the efficacy of silicone oil may be better than air.

En Face OCT Detects Preretinal Abnormal Tissues Before and After Internal Limiting Membrane Peeling in Eyes with Macular Hole

To assess preretinal abnormal tissue (PAT) using en face OCT in eyes with idiopathic macular holes (MHs). Retrospective, observational study. Patients with MH who received 6× 6-mm spectral-domain-OCT scans. Preretinal abnormal tissue was detected by en face OCT images with a custom slab, defined with an anterior boundary of 6 μm anterior to the internal limiting membrane (ILM) and a posterior boundary at 3 μm posterior to the ILM. The PAT was defined as any abnormal tissues observed in en face OCT. Characteristics of preoperative and postoperative PAT. Sixty eyes with MH from 60 patients were included. Fifty-one eyes underwent preoperative analysis, and 46 eyes underwent postoperative examination. Before surgery, 48 (94%) eyes had a mean (standard deviation [SD]) PAT of 6.6 (9.8) mm2. The corresponding cross-sectional OCT showed PAT consisting of epiretinal proliferation, epivascular glia, and a preretinal hyperreflective band. Preretinal abnormal tissue was contiguous to the hole (peri-MH PAT) in 12 eyes (24%), whereas others (36 eyes, 76%) had a scattered distribution (extrafoveal PAT). The area of PAT was greater in eyes with a peri-MH PAT than in eyes with an extrafoveal PAT (P < 0.0001). Compared to the eyes with the extrafoveal PAT, the eyes with the peri-MH PAT were associated with men (P= 0.0059) and worse baseline visual acuity (VA) (P= 0.0002). In eyes with ILM peeling (42 eyes), postoperative PAT proliferation was observed from the edge of the ILM peeling toward the periphery over a 1-year follow-up. The mean (SD) area of PAT at 2 weeks after surgery was 3.4 (3.6) mm2 and increased to 12.1 (6.4) mm2 at 12 months (P < 0.0001). However, no PAT increase was observed in 4 eyes that underwent vitrectomy without ILM peeling. The postoperative PAT size was not associated with the postoperative VA. En face OCT revealed PAT in most eyes with MHs. Peri-MH PAT was associated with worse VA and was seen more frequently in male patients. Postoperative PAT proliferation may be triggered by ILM peeling, but it is not associated with worse VA.

Predictive value of macular hole indices for vitrectomy with ILM peeling combined with ILM flap transposition over the macular hole on macular hole closure

Predictive value of macular hole indices for vitrectomy with ILM peeling combined with ILM flap transposition over the macular hole on macular hole closure

Embedding Technique versus Conventional Internal Limiting Membrane Peeling for Lamellar Macular Holes with Epiretinal Proliferation

To examine the outcomes of pars plana vitrectomy (PPV) with lamellar hole-associated epiretinal proliferation (LHEP) embedding and conventional internal limiting membrane (ILM) peeling for lamellar macular holes (LMHs) with LHEP. Retrospective observational study. Forty eyes of 39 consecutive patients with LMHs and LHEP who underwent 3-port PPV with a minimum follow-up of 3 months. We compared the results of eyes that underwent PPV with LHEP embedding and ILM peeling (group E) with those of eyes that underwent PPV with ILM peeling only (group I) from September 2010 to September 2021. We confirmed whether the LHEP was embedded using postoperative OCT in all the cases. Postoperative best-corrected visual acuity (BCVA) and the development of macular holes (MHs) were assessed. The mean patient age was 73.3 years. The mean follow-up duration was 23.1 months. There were 23 and 17 eyes in groups E and I, respectively. Preoperative BCVA (P= 0.774) and central retinal thickness (CRT) (P= 0.800) did not differ significantly between the 2 groups. The final BCVA in group E was better than that in group I (P= 0.059). The final CRT in group E was thicker than that in group I (P < 0.001). Postoperatively, a significant improvement in BCVA was observed in group E at 3 months (P= 0.001) and at the final visit (P < 0.001). None of the eyes in group E developed postoperative MHs, whereas 5 eyes in group I developed postoperative MHs. Pars plana vitrectomy using the LHEP embedding technique improved visual acuity significantly and yielded better anatomic outcomes than those with PPV using conventional ILM peeling; MH formation did not occur. Embedding LHEP is more effective than conventional surgical procedures for LMHs.

Post-Retinal Detachment Repair Diffuse Tractional Retinoschisis Sparing Region of Internal Limiting Membrane Peel

Post-Retinal Detachment Repair Diffuse Tractional Retinoschisis Sparing Region of Internal Limiting Membrane Peel

AMNIOTIC MEMBRANE GRAFT FOR THE TREATMENT OF LARGE REFRACTORY MACULAR HOLE.

Study off-label human amniotic membrane use outcomes for giant refractory macular hole closure. The study was performed at Lahore General Hospital, Lahore, over 52 months on patients who had undergone standard macular hole surgical procedures for treatment, but the hole failed to close. Refractory macular hole dimensions ranged from 824 µ m to 1,568 µ m. Before surgery, patients underwent slit-lamp examination, fundus photography, and optical coherence tomography for macular scan. Amniotic membrane graft (AMG) used in surgery was harvested from a human placenta 24 hours before. Before AMG application, enough internal limiting membrane peeling was performed to ensure perfect fitting and recovery. All holes were plugged with AMG and SF6 gas tamponade. Twenty-nine patients, 20 men and nine women, were included in this study. Mean age of patients was 58 ± 6. Patients had refractory holes of average 1,237.48 ± 151.25 µ m. Post-op, 100% macular hole closure was achieved in all patients. Type 1 closure was found in patients (37.93%) who underwent AMG surgery within 3 months after primary surgical failure. Type 2 closure was found in patients (62.07%) who were operated on 3 months after primary surgical failure. Refractory macular holes treated by AMG with SF6 gas tamponade achieve anatomical Type 1 closure if performed within 3 months of primary surgical repair.

Effect of Facedown vs Non-Facedown Position on Macular Hole Closure after Surgery

Background: Internal Limiting Membrane (ILM) peeling with Gas tamponade after Pars Plana vitrectomy is routinely done in macular hole surgery. After the procedure, a face-down position (FDP) is advised to the patients to promote macular hole closure by pushing the bubble of Gas against the posterior pole. However, elderly patients and those with medical comorbidities may feel uncomfortable in FDP. A few post-operative complications may also be caused by it. So, the aim of this study is to compare and evaluate the role of postoperative non-face-down position (nFDP) and FDP on the macular hole closure rate after PPV with ILM peeling. Patients and methods: 20 phakic eyes of 20 patients, with idiopathic full-thickness macular holes, underwent vitrectomy, with dye-assisted peeling of the ILM and 14% perfluoro propane gas. Patients were divided randomly into two groups; face down position (FDP, posturing group) or non face down (nFDP, non-posturing group) for 7 days. Main focus was to see anatomical hole closure till 7 days postoperatively. Results: Macular holes closed in 10 of 10 eyes in the posturing (FDP) group and in 9 out of 10 in the non-posturing group (nFDP) seven days after the surgery. Chi-square test was applied to see the association between macular hole closure of patients with / without face down position. It was observed that macular hole closure was less likely to be associated with posturing (X2= 1.2, p-value= 0.549) while it was likely to be associated with size of macular hole (X2= 15.9, p-value= 0.001). In a sub-group analysis according to the size, all the macular holes smaller than 490 µm closed regardless of posturing. While holes larger than 490 µm were not closed in nFDP position. Conclusion: Post-operative face-down position has no statistically significant effect on macular hole closure in comparison to non-face down positioning. Keywords: Macular hole (MH), Face down position (FDP), Posturing, Closure rate, Randomized controlled Trials (RCTs)

Commentary: To evaluate the functional and anatomical outcomes for autologous retinal autograft with Finesse™ Flex Loop for failed macular holes.

Commentary: To evaluate the functional and anatomical outcomes for autologous retinal autograft with Finesse™ Flex Loop for failed macular holes.

Choroidal vascularity index changes with phacovitrectomy for vitreoretinal interface disorders.

Vitreomacular interface disorders have long been argued to change choroidal structure. The aim of this study was to determine the choroidal vascularity index (CVI) changes following internal limiting membrane peeling for epiretinal membrane (ERM) and full thickness macular hole (FTMH). Fifty-nine patients with unilateral ERM and 56 with unilateral FTMH were included in the study. Axial length, pre- and post-surgery intraocular pressure, baseline and post-phacovitrectomy CVI were calculated and compared with the normal fellow eyes. To compare the baseline and the final measurements, Wilcoxon test was used. Mann-Whitney U test was used for independent data comparisons. Median and standard deviations were compared. Axial length, pre- and post-surgery intraocular pressure differences were insignificant between study and fellow eyes within all groups. CVI were significantly lower in post-vitrectomy study eyes of all groups compared with pre-surgery (P < 0.001). There were no significant changes before and after the surgeries in fellow eyes. Baseline CVI of ERM study eyes (median 65.90%) and FTHM study eyes (median 65.59%) did not differ significantly between groups (U = 1336, P = 0.07, r = 0.16). There are conflicting results of vitreoretinal interface disorders CVI in the literature. In this study, both FTMH and ERM eyes showed reduced CVI postoperatively compared with the baseline. Preoperatively, there were no difference between study eyes and the fellow eyes.

Vitrectomy with ILM peeling in diabetic macular edema in one eye vs. intravitreal anti-VEGF injections in the second eye: a comparative study.

The aim of this study was to compare the results of vitrectomy performed in patients' worse eyes with diabetic macular edema to the results of continuous anti-VEGF treatment performed in patients' fellow eyes. A retrospective interventional study of 14 patients with diabetic macular edema in both eyes. The better eye was always qualified for aflibercept injections (group 1), and the worse eye was scheduled for vitrectomy (group 2). The follow-up lasted 12months. The following parameters were measured: visual acuity (V), central retinal thickness (CRT), maximum retinal thickness (MRT), central choroidal thickness (CCT), superficial fovea avascular zone (sFAZ) and deep fovea avascular zone (dFAZ), and vessel density at the level of superficial (sVD) and deep (dVD) retinal vessels. None of the analyzed factors differed between groups with statistical significance at any timepoint. The time of recovery of vision was identical in both eyes (F = 0.91, p = 0.449). The final sFAZ was significantly smaller for group 2 (median 196μm) than for group 1 (median 375μm; U = 101.0; p = 0.022; r = 0.44). Both techniques resulted in similar improvements in visual acuity and decreases in CRT after 1year. sFAZ decreased in all eyes, with a higher extent after vitrectomy.

Sudden branch macular artery avulsion during internal limiting membrane peeling for idiopathic macular hole: A case report.

Introduction and importanceMacular Holes (MH) are variable thickness openings of the retina that develop in the fovea. This case presents a branch macular artery avulsion during internal limiting membrane (ILM) peeling for idiopathic macular hole management in an adult patient. The proper management of this complication along with the preventive measures is mentioned.Case presentationA 65-year-old woman developed a branch macular artery avulsion during ILM peeling for MH. After cataract extraction by phacoemulsification with intraocular lens implantation and pars plana vitrectomy, during ILM peeling, a multifocal bleeding along a macular artery was noted indicating its avulsion. The intraocular pressure was raised to control hemorrhage, blood remnants were passively aspirated and ILM peeling was kindly completed under adequate visualization.Clinical discussionBranch macular artery avulsion is a potential complication even for experienced surgeons. Proper management of this complication involves the increase of intraocular pressure for hemostasia. If hemostasia and proper visualization are achieved, the surgery could be completed, and if it is not the case, the ILM peeling could be completed in a second procedure. This complication might be avoided by initiating the ILM peeling away from the macular vessels.ConclusionBranch macular artery avulsion is an intraoperative complication that might be avoided by initiating the ILM peeling away from the macular vessels.

Foveal-sparing ILM-Peeling mit ILM flap Transposition in einem Fall mit idiopathischem durchgreifendem Makulaforamen

Foveal-sparing ILM-Peeling mit ILM flap Transposition in einem Fall mit idiopathischem durchgreifendem Makulaforamen

Extensive internal limiting membrane peeling for proliferative vitreoretinopathy.

The aim of this study was to describe the anatomical outcomes of Brilliant Blue G (BBG)-assisted extensive internal limiting membrane peeling for proliferative vitreoretinopathy (PVR) under three-dimensional (3D) visualization. This study constitutes a retrospective case series conducted in a private retina practice, of 14 consecutive patients (14 eyes) with rhegmatogenous retinal detachment complicated by PVR who underwent pars plana vitrectomy between January 2019 and January 2020. The internal limiting membrane (ILM) was selectively stained with BBG, and perspectives were enhanced with a 3D visualization system. We peeled off the ILM beyond the vascular arcades up to the periphery. The main outcome was anatomical success, defined as persistent retinal reattachment after removal of the silicone oil tamponade. Anatomic success was achieved with a single surgery in 11 of 14 (78.6%) eyes, and eventual success was achieved in all eyes. The mean patient follow-up time was 12.3months (range, 7-16months). The mean preoperative best-corrected visual acuity (BCVA) was 2.93 ± 0.79 logMAR which improved to 1.75 + 0.91 at the last follow-up. Extensive ILM peeling allowed the creation of a cleavage plane underlying the PVR membranes that facilitated its complete removal, thereby achieving anatomically reattached retina and reducing the risk of recurrence of retinal detachment. The long-term effects of this technique need further research.

Quantitative evaluation of dissociated optic nerve fibre layer (DONFL) following idiopathic macular hole surgery.

To quantitatively evaluate concentric macular dark spots (CMDS) on spectral-domain optical coherence tomography (SD-OCT) to determine the morphological characteristics of dissociated optic nerve fibre layer (DONFL) following the performance of internal limiting membrane (ILM) peeling in patients with full-thickness idiopathic macular hole (IMH) closure. Retrospective study on patients who underwent a vitrectomy with ILM peeling procedure. BCVA, cross-sectional OCT scans, and three-dimensional reconstructions of en face OCT scans were analysed preoperatively, at 2, 6, 12 months post-operatively. A novel image analysis technique was used to automatically measure DONFL logical properties through the radius, area, the nerve fibre layer dissociation index (NFLDI), and depth of the CMDS. 53 eyes of 51 patients were included, and the mean follow-up was 11.53 ± 6.26 months. CMDS was found in 46 (86.79%) eyes within 2 months after ILM peeling and 50 (94.34%) eyes within 6 months after ILM peeling. CMDS concentrated on the temporal side of the macula in all 50 eyes (100%) at first detection. The area, NFLDI, and depth of CMDS in four quadrants developed significantly during the postoperative 6 months (p < 0.05), and then these changes slowed down and remained unchanged 12 months post-operatively. The morphological changes in the temporal quadrant were significantly greater than those in other quadrants at 2, 6, 12 months (all p < 0.05) post-operatively. CMDS mostly appeared and concentrated on the temporal side of the macula in IMHs within two months after ILM peeling and progressed within 6 months and remained unchanged after 12 months.

Functional Outcome After Macular Hole Surgery: Comparison of Standard Perimetry with Microperimetry.

PurposeTo compare the predictive value of macular perimetry and microperimetry for visual outcomes after vitrectomy with internal limiting membrane (ILM) peeling in full-thickness macular holes (MH).MethodsThis retrospective, non-randomized case series refers to 100 eyes undergoing vitrectomy with ILM peeling. Best-corrected visual acuity (BCVA), standard 12° perimetry and microperimetry were perioperatively recorded. A possible predictive value of the preoperative findings on postoperative visual function (PVF) was assessed.ResultsIndependent of the preoperative minimal MH size (range: 55–752 μm), all 100 MHs were closed. BCVA improved from 56.3 ± 12.8 to 74.8 ± 9.2 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters after six months and retinal fixation stability enhanced. We found a positive correlation between BCVA and macular sensitivity 6 months postoperatively in microperimetry (r = 0.48, p < 0.010) and 12° perimetry (r = 0.45, p < 0.014), as well as with mean defect (r = 0.48, p < 0.01 and r = 0.44, p < 0.017, respectively). A correlation between preoperative visual function indices and PVF was not established.ConclusionMicroperimetry and standard perimetry are equally suitable for describing perioperative retinal function in idiopathic MH. While the indices of both methods correlate comparably well with BCVA, they cannot predict PVF. This may be partially explained by the area covered by perimetry, compared to which the size of the MH is of inferior relevance.

Modified superior inverted internal limiting membrane flap technique with vitrectomy versus vitrectomy with internal limiting membrane peeling for retinal detachment with myopic macular hole

PurposeTo evaluate the efficacy of the modified superior inverted internal limiting (ILM) membrane flap technique in retinal reattachment, macular hole closure and external retinal layers restoration in macular hole associated retinal detachment compared to ILM peeling. MethodsRetrospective case series of 10 patients that required pars plana vitrectomy for retinal detachment with macular hole followed for more than 12 months. Data from medical records were retrospectively collected and patients were divided into the superior inverted flap (5 patients) and ILM peeling group (5 patients). We compared best corrected visual acuity (BCVA) before and after surgery, retinal attachment, macular hole closure rate and external retinal layer restoration between groups. ResultsThere were significant improvements in BCVA in both groups before and after surgery, with no differences between the two groups at 12 months after surgery (p=0.9). The macular hole closed in 100% of cases in the inverted flap group and 80% of the ILM peeling group with no significant differences between groups. The retina was reattached in 100% of cases in both groups. Only 2 patients in the inverted flap group (40%) had external retinal layer restoration and none in ILM peeling group (p=0.62). ConclusionsILM peeling and superior inverted flap techniques are useful for treating retinal detachment with macular hole in myopic eyes.

Inverted multi-layer internal limiting membrane flap for macular hole retinal detachment in high myopia

To investigate the surgical outcomes of pars plana vitrectomy (PPV) combined with inverted multi-layer internal limiting membrane (ILM) flap for the treatment of macular hole retinal detachment in high myopia. We retrospectively analysed the medical records of macular hole retinal detachment (MHRD) patients with high myopia. The patients were divided into two groups with different surgical procedure: inverted multi-layer ILM flap group (group 1, 27 eyes) and the ILM peeling group (group 2, 29 eyes). Retinal reattachment rate, macular hole closure rate at last follow-up and BCVA at 6 months post-operation were compared between the two groups. After primary PPV and silicone oil removal, the retinal reattachment rate was 96.3% in group 1 and 93.1% in group 2 respectively at last follow-up, showing no statistically significant difference (odds ratio = 0.525, P = 1.000). All eyes in group 1 had type I macular closure (100%, 27/27), while only 7 eyes (24.1%, 7/29) in group 2 have type I macular hole closure. The difference was statistically significant (odds ratio = 0, P < 0.05). The mean logMAR BCVA both improved significantly at 6 months post-operation compared with pre-operation (t = 4.181, P < 0.001; t = 3.217, P < 0.001), however the difference of post-operation BCVA between the two groups was not statistically significant (t = 0.906, P > 0.05). PPV combined with inverted multi-layer ILM flap could achieve better anatomical outcomes than ILM peeling technique with no significant advantage in functional outcomes.

Epiretinal membrane fragments: the origin of recurrent membranes after epiretinal membrane peeling

ObjectifExaminer le rôle des résidus de membrane épirétinienne (MER) dans le contexte d'une récurrence de MER après une vitrectomie par la pars plana (VPP) réalisée pour retirer une MER. NatureÉtude comparative rétrospective. ParticipantsUn total de 195 yeux de 195 patients ayant subi une VPP pour cause de MER. MéthodesOn a retiré la limitante interne sans avoir recours au bleu brillant G (BBG) jusqu'en mai 2017 (groupe 1) et en utilisant le BBG dans tous les yeux par la suite (groupe 2). Des images ont été obtenues grâce à la tomographie par cohérence optique (OCT) 3 jours et 3 ans après la VPP. RésultatsLe groupe 1 comptait 87 yeux, et le groupe 2, 108 yeux. Les images à l'OCT obtenues 3 jours après la VPP ont mis au jour des résidus de MER de même qu'un plissement de la surface rétinienne dans 53 yeux (27,2 %) et seulement un plissement de la surface rétinienne dans 9 yeux (4,6 %). Les images obtenues à l'OCT 3 ans après l'intervention ont révélé la présence d'une MER dans 63 yeux (32,3 %). À l'exception d'un seul œil, tous les yeux présentaient des résidus de MER et/ou un plissement de la surface rétinienne à l'OCT 3 jours après la VPP. Les résidus de MER présents 3 jours après l'intervention se sont agrandis dans 20 (64,5 %) des 31 yeux qui présentaient des résidus de MER 3 jours après l'intervention dans le groupe 1 et dans 5 (22,7 %) des 22 yeux qui présentaient des résidus de MER 3 jours après l'intervention dans le groupe 2, soit une différence significative (p = 0,003). ConclusionsLes résidus de MER peuvent donner lieu à une récurrence de MER après une VPP. Le retrait de la limitante interne réalisée avec injection de BBG peut empêcher la croissance des résidus de MER. L’élimination des résidus de MER et de limitante interne pendant l'intervention peut diminuer efficacement le risque de devoir réaliser une nouvelle chirurgie pour retirer la MER.

Progress in the treatment of refractory macular hole by human amniotic membrane

The surgery of refractory macular hole is often very tough for its uncertain prognosis. There is no unified definition for refractory macular hole, which usually refers to macular hole with a long duration, large diameter, or failure of initial operation. Treatment success can be achieved in some cases by expanding the range of internal limiting membrane peeling or filling with autologous tissue. Human amniotic membrane is a kind of tissue with strong anti-inflammatory and anti-fibrosis effects, and has been widely used in the treatment of ocular surface diseases. In recent years, amniotic membrane has been used in treating refractory macular hole. Some positive results have been achieved, including improvement of postoperative macular structure and increase of visual function. This review focuses on the mechanism, efficacy and prospect of human amniotic membrane in the treatment of refractory macular hole, providing reference for clinical practice and research.