Staining and Sizing Technique for Human Amniotic Membrane Graft in Refractory Macular Holes

Purpose: To describe the triple S technique for aiding the visualization (staining), preparation (sizing), and placement (sliding) of human amniotic membrane grafts in cases of refractory macular holes (MHs). Methods: Brilliant blue-green dye was used to stain the graft before insertion for improved visualization and to aid in its orientation. Preoperative optical coherence tomography-based sizing of the graft was performed, and a dermal trephine was used to fashion the graft according to size. Once placed in the eye, the graft was positioned by bimanually sliding it into the MH using a nitinol loop and a Tano brush. Results: Seven eyes of 7 patients had repair of a refractory MH. Anatomic closure was successful in all patients with no postoperative displacement or dislodgement of the graft. The mean logMAR (±SD) visual acuity was 1.80 ± 0.4 preoperatively and 1.27 ± 0.6 at the final follow-up. Conclusions: The triple S technique provided adequate visualization, sizing, and placement of amniotic membrane grafts in cases of refractory MHs. This modification may help reduce the learning curve associated with this technique.