Enhancing Internal Limiting Membrane Inverted Flap Outcomes With Amniotic Solution for Chronic and Large Macular...

Area of Science:

• Ophthalmology
• Regenerative Medicine

Background:

• Macular holes, particularly large, chronic, and idiopathic types, present significant challenges in visual restoration.
• Current surgical techniques for macular hole repair have varying success rates and can be associated with complications.

Purpose of the Study:

• To evaluate the efficacy of a modified inverted internal limiting membrane (ILM) flap technique combined with human amniotic membrane (hAM) solution for treating large, chronic, and idiopathic macular holes.
• To compare two methods of hAM preparation for surgical application.

Main Methods:

• Pars plana vitrectomy was performed on 14 eyes using a temporal ILM flap technique and hAM application.
• Two hAM preparation methods were assessed: direct injection of an hAM suspension versus a refined homogeneous hAM solution created using a vitrectomy probe.
• All eyes were tamponed with 20% sulfur hexafluoride (SF6).

Main Results:

• All cases demonstrated significant improvements in best-corrected visual acuity and successful macular hole closure.
• The homogeneous hAM solution group exhibited superior anatomical and functional outcomes compared to the hAM suspension group.
• Enhanced retinal layer integration was observed with the homogeneous hAM solution, without adverse events like fragment displacement or visual disturbances.

Conclusions:

• Human amniotic membrane solution serves as a promising adjunct in macular hole surgery, aiding in flap stabilization and promoting retinal regeneration.
• The refined method for preparing a homogeneous hAM solution offers better surgical outcomes.
• Further extensive research is warranted to validate the long-term effectiveness and safety of this approach.