Human amniotic membrane grafting for chronic macular hole repair

To present anatomical and functional outcomes of human amniotic membrane (hAM) grafting for the repair of chronic and refractory macular holes (MH).

Twenty-four eyes with chronic or persistent MH were included. Eleven patients had a history of failed pars plana vitrectomy (PPV) to repair the MH and underwent secondary hAM grafting (Group 1). Thirteen patients underwent primary PPV combined with hAM grafting (Group 2). Chronic MH was defined as symptom duration > 12 months or persistence after previous unsuccessful PPV. A cryopreserved hAM graft was placed underneath the MH edges with the chorionic side facing the retinal pigment epithelium (RPE). Air tamponade was used for all patients, with 24-h face-down positioning.

The mean age of the patients was 68.8 ± 6.1 (55-78) years; male/female ratio was 8/16. The mean best-corrected visual acuity (BCVA) improved from 1.3 ± 0.1 (2-0.7) LogMAR preoperatively to 0.7 ± 0.8 (2-0.2) LogMAR postoperatively (p < 0.01). Median basal MH diameter was 1501.8 ± 351.1 (1043-2550) µm; minimum MH diameter was 727.8 ± 198.7 (517-1230) µm. Type 1 closure was achieved in 79.2% and type 2 closure in 20.8% of cases; several type 2 closures evolved into type 1 over time. Closure rate was 100% with a single surgery in both groups.

hAM grafting is an effective technique for closure of chronic or persistent MH, achieving 100% anatomic success. Type 2 closures may evolve into type 1 over time, suggesting dynamic postoperative healing. Further studies with larger cohorts and longer follow-up are warranted.