Refractory macular hole surgery with amniotic membrane transplant functional assessment

TL;DR

This study shows that using amniotic membrane transplants in surgery can successfully close refractory macular holes and improve vision.

Contribution

The study introduces amniotic membrane transplants as an effective treatment for refractory macular holes.

Findings

Amniotic membrane grafts successfully closed all refractory macular holes in patients.

Visual acuity improved significantly after surgery, with a mean logMAR improvement from 1.70 to 1.12.

Multifocal electroretinography (mfERG) parameters showed significant improvements in P1 amplitude and implicit time.

Abstract

To evaluate refractory macular hole (MH) surgery with amniotic membrane transplant functional outcomes.

Prospective study over a five-year period. Nineteen patients with full-thickness macular hole (15 refractory MH and 4 chronic ≥ 8 years MH) were included. All patients underwent vitrectomy, cryopreserved amniotic membrane subretinal graft, tamponade and positioning. Functional outcomes were assessed using best-corrected visual acuity, M-CHARTS™ and mfERG (P1 and N1 waves amplitude and implicit time in five rings and ratios) preoperatively, at 3- and 12-months follow-up. Optical coherence tomography was also performed for structure-function analysis.

Mean follow-up was 45 months (range 15–68). Mean MH minimum linear diameter was 819 ± 242 μm and base diameter was 1387 ± 346 μm. After surgery, MH closed in all patients. Mean logarithm of the minimum angle of resolution (logMAR) visual acuity improved significantly from 1.70 ± 0.40 to 1.12 ± 0.39 (p < 0.001), mean first ring P1 amplitude, P1 implicit time, N1 amplitude and ratio 2 increased significantly (ß = 19.82, p = 0.029), (ß = 6.72, p = 0.033), (ß = 10.76, p = 0.007) and (ß = 0.836, p = 0.011), respectively. Foveal peak improved in 60% patients, one third presenting eccentric positioning.

Visual acuity, metamorphopsia and mfERG improvements postoperatively suggest that amniotic membrane graft may be a useful tool to achieve refractory macular hole closure and enhanced functional outcomes.

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