EPIRETINAL HUMAN AMNIOTIC MEMBRANE GRAFT SURGERY FOR MACULAR HOLE WITH MACULAR TELANGIECTASIA TYPE 2

Macular telangiectasia (MacTel) type 2 is a progressive neurodegenerative condition with complications including macular hole. Conventional repair of an associated hole does not reliably improve vision despite an increasing number of described and advanced surgical techniques. The study objective was to determine whether epiretinal human amniotic membrane grafting can restore anatomy and vision in eyes complicated by macular hole with MacTel.

In this international, multicenter, interventional case series, three patients with macular hole and MacTel consented to surgical repair with pars plana vitrectomy and epiretinal human amniotic membrane grafting. One had at least two prior vitrectomies with initially successful full-thickness macular hole closure that reopened, years in between surgeries, before graft surgery. One had a persistent full-thickness macular hole refractory to vitrectomy with membrane peeling, before electing graft surgery. The remaining patient was treatment naïve. Best-corrected visual acuity (BCVA) and parafoveal anatomy by spectral-domain optical coherence tomography (SD-OCT) were assessed at minimum 6 postoperative months.

All three patients successfully completed epiretinal human amniotic membrane graft surgery with anatomic hole closure and partial reconstitution of parafoveal anatomy evident by SD-OCT. BCVA improved in all cases from baseline (range: 20/400-20/150) to last postoperative visit (range: 20/125-20/70).

MacTel remains a challenging neurodegenerative condition with limited surgical options for complications including macular hole. Epiretinal human amniotic membrane grafting could be a viable surgical approach for obtaining macular hole closure, improving vision, and restoring substantial parafoveal anatomy in the appropriate clinical context and warrants additional consideration.