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.

Figures

Figure 1
Figure 1
Intraoperative snapshots describing the surgical technique for insertion of human amniotic membrane (hAM) plug inside the macular hole (MH): (a) Fashioning the freshly acquired amniotic membrane graft according to the MH size. (b and c) Holding the hAM graft with the help of forceps and using the blunt end of the forceps to insert the hAM under the edges of the MH. (d) Performing perfluorocarbon liquid–air exchange away from the hAM graft to avoid the displacement of hAM from the MH
Figure 2
Figure 2
Pre and postoperative outcomes of a patient with idiopathic full-thickness macular hole (MH) having undergone primary human amniotic membrane (hAM) plug surgery (case 2, Group A). (a) This patient developed a large full-thickness primary MH (outer diameter = 897 μ). The patient underwent pars plana vitrectomy with internal limiting membrane peeling with hAM plugging into the MH in the primary surgery itself. (b and c) Optical coherence tomography image at 2-week and 4-week post-surgery shows the MH closed and hAM plug in situ (arrow with red border). The external limiting membrane and ellipsoid layer have not yet differentiated. Multicolor image shows the hAM plug to be integrated under the macula (arrow with red border)
Figure 3
Figure 3
Pre and postoperative outcomes of a patient with full-thickness macular hole (MH) with retinal detachment having undergone primary human amniotic membrane (hAM) plug surgery (case 3, Group A). (a) This patient developed a posterior pole retinal detachment secondary to a large full-thickness MH. The patient underwent pars plana vitrectomy with internal limiting membrane peeling with hAM plugging into the MH in the primary surgery itself. (b and c) Optical coherence tomography image at 2-week and 4-week post-surgery shows the MH closed with hAM plug in situ and gradually resolving subretinal fluid (arrow with white border). The external limiting membrane and ellipsoid layer have not yet differentiated
Figure 4
Figure 4
Graph showing best corrected visual acuity changes of eyes undergoing primary and secondary human amniotic membrane plug transplantation
Figure 5
Figure 5
Pre and postoperative outcomes of a patient with re-opened full-thickness macular hole (MH) having undergone secondary human amniotic membrane (hAM) plug surgery (case 6, Group B). (a) This patient redeveloped a large full-thickness primary MH (outer diameter = 2185 μ) following initial MH repair surgery. The patient underwent hAM plugging into the MH 4 weeks after the primary surgery. (b and c) Optical coherence tomography image at 2-week and 4-week post-surgery shows the MH closed and hAM plug in situ (arrow with red border). The external limiting membrane and ellipsoid layer have differentiated over the hAM graft. (d) At 12-week final follow-up visit, the macula still remains closed with shrinking hAM plug in situ and integrated with the retina (arrow with white border). The patient had undergone cataract surgery with intraocular lens implantation, and final visual acuity improved to 0.3 logMAR

References

    1. 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.
    1. Grueterich M, Tseng SC. Human limbal progenitor cells expanded on intact amniotic membrane ex vivo. Arch Ophthalmol Chic Ill 1960. 2002;120:783–90.
    1. Meller D, Dabul V, Tseng SC. Expansion of conjunctival epithelial progenitor cells on amniotic membrane. Exp Eye Res. 2002;74:537–45.
    1. Anderson DF, Prabhasawat P, Alfonso E, Tseng SC. Amniotic membrane transplantation after the primary surgical management of band keratopathy. Cornea. 2001;20:354–61.
    1. Ashraf NN, Adhi MI. Outcome of application of amniotic membrane graft in ocular surface disorders. JPMA J Pak Med Assoc. 2017;67:1045–9.
    1. 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.
    1. Kim JS, Kim JC, Hahn TW, Park WC. Amniotic membrane transplantation in infectious corneal ulcer. Cornea. 2001;20:720–6.
    1. 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.
    1. Lee SH, Tseng SC. Amniotic membrane transplantation for persistent epithelial defects with ulceration. Am J Ophthalmol. 1997;123:303–12.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. Grewal DS, Mahmoud TH. Autologous neurosensory retinal free flap for closure of refractory myopic macular holes. JAMA Ophthalmol. 2016;134:229–30.
    1. 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.
    1. 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.
    1. 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.
    1. 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

スポンサーと協力者

医学的状態

薬物療法

3
購読する