Novel Method of Plugging the Hole: Anatomical and Functional Outcomes of Human Amniotic Membrane-Assisted Macular Hole Surgery
Naresh Kumar Yadav, Ramesh Venkatesh, Sherina Thomas, Arpitha Pereira, K Bhujang Shetty, Naresh Kumar Yadav, Ramesh Venkatesh, Sherina Thomas, Arpitha Pereira, K Bhujang Shetty
Abstract
Purpose: To describe the surgical outcomes of macular holes (MHs) by inserting a human amniotic membrane (hAM) plug.
Methods: In this retrospective, interventional, comparative case series, 10 patients who had undergone hAM plugging for a MH were included in the study. Seven patients had idiopathic full-thickness MHs, 1 patient had traumatic MH, and 1 patient each had a MH-induced retinal detachment and combined retinal detachment. The control group included 10 cases with similar configuration and duration of MHs treated with the inverted peeling of the internal limiting membrane technique. All patients underwent a standard 3-port, 25-gauge transconjunctival pars plana vitrectomy and hAM plug transplantation in the subretinal space under the MH. The anatomic and functional outcomes were assessed at 4 weeks postsurgery.
Results: At the 4-week follow-up visit, all the MHs in the hAM plug group achieved hole closure, whereas 80% of the eyes in the control group were able to achieve hole closure. Improvement of 0.1 logMAR vision was noted in 8 of the 10 patients. At the 4-week follow-up visit, the external limiting membrane and ellipsoid zone layer continuity over the hAM was defined only in one case. No significant difference was found between the hAM plug group and controls in visual and anatomical responses. No complications following hAM transplantation such as rejection, endophthalmitis, or hypotony were noted following surgery.
Conclusion: Subretinal hAM graft transplantation can be a useful option in the repair of primary or refractory MHs not only for achieving anatomic closure but also for the accompanying visual improvement.
Keywords: Amniotic membrane transplantation; Macular hole; Outcomes; Surgery.
Conflict of interest statement
There are no conflicts of interest.
Copyright: © 2020 Journal of Current Ophthalmology.
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References
- van Herendael BJ, Oberti C, Brosens I. Microanatomy of the human amniotic membranes.A light microscopic, transmission, and scanning electron microscopic study. Am J Obstet Gynecol. 1978;131:872–80.
- Grueterich M, Tseng SC. Human limbal progenitor cells expanded on intact amniotic membrane ex vivo. Arch Ophthalmol Chic Ill 1960. 2002;120:783–90.
- Meller D, Dabul V, Tseng SC. Expansion of conjunctival epithelial progenitor cells on amniotic membrane. Exp Eye Res. 2002;74:537–45.
- Anderson DF, Prabhasawat P, Alfonso E, Tseng SC. Amniotic membrane transplantation after the primary surgical management of band keratopathy. Cornea. 2001;20:354–61.
- Ashraf NN, Adhi MI. Outcome of application of amniotic membrane graft in ocular surface disorders. JPMA J Pak Med Assoc. 2017;67:1045–9.
- Bandeira F, Yam GH-F, Fuest M, Shing Ong H, Liu YC, Shen SY, et al. Urea-de-epithelialized human amniotic membrane for ocular surface reconstruction. Stem Cells Transl Med. 2019;8:620–6.
- Kim JS, Kim JC, Hahn TW, Park WC. Amniotic membrane transplantation in infectious corneal ulcer. Cornea. 2001;20:720–6.
- Le Q, Deng SX. The application of human amniotic membrane in the surgical management of limbal stem cell deficiency. Ocul Surf. 2019;17:221–9.
- Lee SH, Tseng SC. Amniotic membrane transplantation for persistent epithelial defects with ulceration. Am J Ophthalmol. 1997;123:303–12.
- Letko E, Stechschulte SU, Kenyon KR, Sadeq N, Romero TR, Samson CM, et al. Amniotic membrane inlay and overlay grafting for corneal epithelial defects and stromal ulcers. Arch Ophthalmol Chic Ill 1960. 2001;119:659–63.
- Siu GD, Kam KW, Young AL. Amniotic membrane transplant for bullous keratopathy: Confocal microscopy & anterior segment optical coherence tomography. Semin Ophthalmol. 2019;34:163–7.
- Sahay P, Goel S, Maharana PK, Sharma N. Amniotic membrane transplantation in acute severe ocular chemical injury: A randomized clinical trial. Am J Ophthalmol. 2019;205:202–3.
- Rosenthal P, Cotter JM. Surgical reconstruction of the ocular surface in advanced ocular cicatricial pemphigoid and Stevens-Johnson syndrome. Am J Ophthalmol. 1996;122:914–5.
- Ohno-Matsui K, Ichinose S, Nakahama K, Yoshida T, Kojima A, Mochizuki M, et al. The effects of amniotic membrane on retinal pigment epithelial cell differentiation. Mol Vis. 2005;11:1–10.
- Stanzel BV, Espana EM, Grueterich M, Kawakita T, Parel JM, Tseng SC, et al. Amniotic membrane maintains the phenotype of rabbit retinal pigment epithelial cells in culture. Exp Eye Res. 2005;80:103–12.
- Kiilgaard JF, Scherfig E, Prause JU, la Cour M. Transplantation of amniotic membrane to the subretinal space in pigs. Stem Cells Int. 2012;2012:716968.
- Capeáns C, Piñeiro A, Pardo M, Sueiro-López C, Blanco MJ, Domínguez F, et al. Amniotic membrane as support for human retinal pigment epithelium (RPE) cell growth. Acta Ophthalmol Scand. 2003;81:271–7.
- Pak KY, Park KH, Kim KH, Park SW, Byon IS, Kim HW, et al. Topographic changes of the macula after closure of idiopathic macular hole. Retina Phila Pa. 2017;37:667–72.
- Rizzo S, Caporossi T, Tartaro R, Finocchio L, Franco F, Barca F, et al. A human amniotic membrane plug to promote retinal breaks repair and recurrent macular hole closure. Retina. 2019;39:S95–103.
- Caporossi T, Tartaro R, De Angelis L, Pacini B, Rizzo S. A human amniotic membrane plug to repair retinal detachment associated with large macular tear. Acta Ophthalmol. 2019;97:821–3.
- Zhu D, Jin X, Zhou J. Transplantation of amniotic membrane for choroidal hole to treat suprachoroidal silicone oil migration. Acta Ophthalmol (Copenh) 2017;95:e522–3.
- Morizane Y, Shiraga F, Kimura S, Hosokawa M, Shiode Y, Kawata T, et al. Autologous transplantation of the internal limiting membrane for refractory macular holes. Am J Ophthalmol. 2014;157:861–9.e1.
- De Novelli FJ, Preti RC, Ribeiro Monteiro ML, Pelayes DE, Junqueira Nóbrega M, Takahashi WY. Autologous internal limiting membrane fragment transplantation for large, chronic, and refractory macular holes. Ophthalmic Res. 2015;55:45–52.
- Grewal DS, Mahmoud TH. Autologous neurosensory retinal free flap for closure of refractory myopic macular holes. JAMA Ophthalmol. 2016;134:229–30.
- Thomas AS, Mahmoud TH. Subretinal transplantation of an autologous retinal free flap for chronic retinal detachment with proliferative vitreoretinopathy with and without macular hole. Retina Phila Pa. 2018;38:S121–4.
- Chen SN, Yang CM. Lens capsular flap transplantation in the management of refractory macular hole from multiple etiologies. Retina Phila Pa. 2016;36:163–70.
- Peng J, Chen C, Jin H, Zhang H, Zhao P. Autologous lens capsular flap transplantation combined with autologous blood application in the management of refractory macular hole. Retina Phila Pa. 2018;38:2177–83.
- Lee SM, Kwon HJ, Park SW, Lee JE, Byon IS. Microstructural changes in the fovea following autologous internal limiting membrane transplantation surgery for large macular holes. Acta Ophthalmol (Copenh) 2018;96:e406–8.
Source: PubMed