Persistent macular hole repair with human amniotic membrane graft

Author: Nisa Silva (Portugal)

Co-authors: Natália Ferreira

Purpose

To report the surgical technique using pars plana vitrectomy (PPV) and human amniotic membrane (hAM) graft in the repair of a persistent macular hole (MH).

Setting/Venue

Ophthalmology Department, Centro Hospitalar Universitário do Porto

Methods

Non-applicable

Results

A 70-year-old male was diagnosed with an MH in the left eye which failed to close after PPV and internal limiting membrane (ILM) peeling. A 23-gauge 3-port PPV and hAM graft was performed. A 25-gauge chandelier endo-illuminator was placed to allow for the bimanual technique. An intraocular dye (doubledyne®) was used to confirm the complete peeling of the ILM and to improve the visualization of the MH edges. The hAM was defrosted in the operating room and a suture helped to mark the basement membrane side. A graft was cut with scissors and, then, unfolded with the basement membrane faced up and the stroma faced down. The hAM graft was introduced into the vitreous cavity with serrated forceps. Within the eye, the graft was carefully trimmed to a smaller size by shaving with a vitrectomy probe. The graft was placed over the MH and gently inserted into the submacular space. The correct positioning of the graft was confirmed after careful fluid/air exchange. SF6 gas was used as a tamponade. Face-down position was recommended for 5 days after surgery. Although visual acuity was 20/100 as in the preoperative visit, the MH was closed at 1 month and 3 months after surgery.

Conlusions

PPV combined with hAM graft is a promising technique for persistent and recurrent MHs in the absence of ILM. The technical difficulty and time of surgery of hAM graft seem to be similar to ILM graft, but the first is more expensive. As shown in this case, the hAM graft has demonstrated high anatomical success.

Financial Disclosure

No financial disclosure