Amniotic membrane subretinal placement to promote closure of persistent full-thickness macular holes

Abstract

Purpose : We report a case series of patients with persistent macular holes who underwent human amniotic membrane (hAM) subretinal placement to achieve successful anatomic macular hole closure.

Methods : This is a retrospective review of a non-consecutive case series conducted at New York Eye and Infirmary of Mount Sinai. There were 10 patients from March 2019 to May 2020 who presented with persistently open full-thickness macular holes. All patients underwent subretinal hAM subretinal placement to promote closure of recalcitrant, full-thickness macular holes.

Results : Ten patients, 6 females and 4 males were included in the series. The mean age was 56.7 years (range 20-77 years). Eight of the patients had already undergone pars plana vitrectomy with internal limiting membrane peeling and gas or silicone oil tamponade. One patient's previous surgical history was unknown. One patient had a chronic full-thickness macular hole for over a decade. The mean preoperative BCVA was 1.6 logMAR (20/800) ranging from 2 to 0.8 logMAR (20/2000 – 20/150). Eight patients received gas as tamponade, of which 5 patient received SF6 20-25% and 3 patients received C3F8 10-14%. Two patients received silicone oil as tamponade. Patients were examined 1 day, 1 week, 1 month, 3 months and 6 months. An optical coherence tomography scan was performed at every visit. BCVA improved from mean 1.6 logMAR preoperatively (20/800) to 1.4 logMAR (20/500) 1-month after the surgery. At the 3-month post-operative visit, the BCVA improved to 1.1 logMAR (20/250), for 9 of the 10 patient records available. In all 10 cases, the macular hole appeared closed at the 1 week post-operative visit and remained closed at their last follow-up exam. OCT showed macular hole closure in all the cases. No adverse events such as increase in intraocular pressure or intraocular inflammation were reported during the post-operative period.

Conclusions : For large, chronic, recurrent, or persistent macular holes, the use of amniotic membrane subretinal transplantation may serve as a useful surgical adjunct to promote macular hole closure.

This is a 2021 ARVO Annual Meeting abstract.