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Human Amniotic Membrane Subretinal Implant in Large Refractory Macular Hole

Alfredo Borgia, MD, Davide Allegrini, MD, Diego Vezzola, MD, Enrico Giacomotti, MD, Gabriella Ricciardelli, MD, Mariantonia Ferrara, MD, Mario R. Romano, MD, PhD, Tania Sorrentino, MD

The patient was referred for a large refractory macular hole (MH; diameter of 800 microns) in the right eye 4 months after primary surgery (pars plana vitrectomy with conventional ILM peeling). Visual acuity was 20/400. We performed a combined procedure—phacoemulsification with IOL implantation and pars plana vitrectomy with enlargement of the previous ILM peeling and subretinal implant of human amniotic membrane (h-AM) plug. The h-AM was implanted with the stroma (sticky side) towards the RPE. At the first follow-up visit (10 days after surgery), the OCT scans showed MH closure with a stratified neuroretina covering the implant and the partial restoration of ELM. On OCT angiography, the superficial and deep capillary free zone were within the normal limits. Visual acuity improved to 20/100. The subretinal h-AM can act both as a scaffold for the migration of retinal cells and as a source of growth factors, potentially improving and modulating the gliotic intraretinal response.

Posted: 9/25/2019