The F-Sign Technique for Human Amniotic Membrane Orientation During Vitreoretinal Surgery

Area of Science:

• Ophthalmology
• Regenerative Medicine
• Surgical Innovation

Background:

• Massive subretinal hemorrhage presents complex surgical challenges.
• Accurate orientation of human amniotic membrane (hAM) grafts is critical for successful subretinal implantation.
• Existing methods for graft orientation verification can be difficult in complex vitreoretinal procedures.

Purpose of the Study:

• To introduce a simple and reproducible marking technique for human amniotic membrane (hAM) epithelial orientation.
• To confirm correct graft placement during subretinal implantation in challenging vitreoretinal surgeries.
• To address the risks associated with incorrect graft placement due to tissue transparency and manipulation.

Main Methods:

• A case report detailing a single-surgeon's approach to massive subretinal hemorrhage.
• Utilized 23-gauge pars plana vitrectomy, retinal turnover, and subretinal hAM implantation.
• Applied a gentian violet dye "F" mark to the hAM epithelial surface before intraocular insertion for orientation identification.

Main Results:

• The gentian violet "F" mark provided clear visualization of graft orientation during forceps insertion and subretinal placement.
• Immediate confirmation of correct graft orientation and stromal-to-retinal pigment epithelium apposition was achieved.
• Postoperative optical coherence tomography (OCT) confirmed accurate graft positioning and stable retinal reattachment, with visual acuity improvement.

Conclusions:

• Gentian violet "F" marking is a safe, straightforward, and reproducible adjunct for hAM graft orientation.
• This technique mitigates the risk of incorrect graft placement in complex vitreoretinal surgery.
• The method enhances surgical precision and patient outcomes in challenging cases.