Human amniotic membrane graft removal and histopathologic evaluation following closure of a full thickness macular...

Human amniotic membrane (hAM) grafts have been used to close persistent macular holes in recent years. The results from these surgeries are promising with improved closure rate and vision. However, there is lack of data for what happens to these membranes and how long the tissue should remain inside the patient's eyes. We report a case of hAM graft removal 6 months after closure of a persistent macular hole and the histopathology result of the removed hAM graft.

This is a report of a 57-year-old male patient that presented with hand motion vision, bullous, macula off rhegmatogenous retinal detachment in his right eye with multiple retinal holes and tears. Patient had 25G pars plana vitrectomy (PPV) with membrane peel and perfluoro-n-octane (PFO), silicone oil (SO) tamponade. After the first surgery, patient's retina reattached with a full thickness macular hole. Four months later, patient underwent PPV, SO removal, membrane peel and 20 % gas sulfur hexafluoride (SF6) tamponade. After the second surgery, the patient's macular hole remained open. Three months after the second surgery, we performed the third surgery with placement of dehydrated human amniotic/chorionic membrane (DHACM AMNIOFIX) over the macular hole and SO tamponade. Follow-up optical coherence tomography (OCT) showed the dehydrated amniotic/chorionic membrane (DHACM) integrated into the inner retina and the macular hole closed. However, the patient experienced obstruction of his central vision due to the graft. Six months after the third surgery, we removed the patient's silicone oil and the DHACM. After DHACM removal, the patient's vision improved to 20/80 and the OCT showed that the macular hole remained closed with restoration of macular layers. The histopathology examination of the removed DHACM did not show retinal tissue attachment.

This case shows the efficacy of dehydrated human amniotic membrane (hAM) graft to close a persistent full thickness macular hole and restore retinal layers. OCT imaging, prior to hAM removal, noted the hAM integration into the inner retina. In addition, we show that the graft can be removed after 6 months without obvious damage to the retina.