EFFICACY AND SAFETY OF AMNIOTIC MEMBRANE TRANSPLANTATION IN VITRECTOMY FOR EXTRA-LARGE OR LONG-STANDING MACULAR HOLES: A Prospective Clinical Study.

PURPOSE: To evaluate the efficacy and safety of amniotic membrane transplantation during vitrectomy for extra-large or long-standing macular holes (MH).

METHODS

A single-center, noncomparative prospective observational study included eight eyes from eight patients with extra-large or long-standing MHs (six recurrent, two primary). All patients underwent vitrectomy with amniotic membrane transplantation over the MH. Baseline assessments included best-corrected visual acuity, optical coherence tomography, multifocal electroretinography, macula microperimetry, and adaptive optics imaging to evaluate photoreceptor cells on the graft surface. Outcome measures were recorded during follow-up.

RESULTS

All eight eyes achieved MH closure during the follow-up period, with 1 case developing amniotic membrane graft displacement that did not cause MH recurrence. After the follow-up ended, at 18 months postoperatively, this case experienced a recurrence of the MH due to rhegmatogenous retinal detachment(mean follow-up: 14.3 ± 8.1 months). Baseline MH diameter was 825.2 ± 265.9 µ m. Best-corrected visual acuity improved in four eyes (50%) and stabilized in others. Multifocal electroretinography showed increased amplitude and shortened peak time at 1 month postoperatively, peaking at 3 months and stabilizing by 6 months. Microperimetry revealed improved retinal sensitivity in five eyes (62.5%), with enhanced 2° and 4° fixation rates. Absolute scotomas resolved posttreatment. Adaptive optics imaging confirmed photoreceptor cell attachment on the graft surface. No adverse events related to the amniotic membrane were observed.

CONCLUSION

Amniotic membrane transplantation facilitates extra-large or long-standing MH closure, improves macular function, and demonstrates favorable safety. This approach may enhance photoreceptor recovery, supporting its clinical utility.