LARGE-SIZED HUMAN AMNIOTIC MEMBRANE PATCHING-ASSISTED VITRECTOMY FOR THE MANAGEMENT OF POSTOPERATIVE PROLIFERATIVE VITREORETINOPATHY IN COMPLEX RHEGMATOGENOUS RETINAL DETACHMENTS.

PURPOSE: To evaluate large-sized human amniotic membrane (hAM) patch-assisted vitrectomy for managing postoperative proliferative vitreoretinopathy (PVR) in complex rhegmatogenous retinal detachment (RRD).

METHODS

A retrospective analysis of 12 eyes (12 patients) with complex RRD and severe PVR undergoing large-sized hAM patch-assisted vitrectomy. Indications included open globe injury-associated RRD (n = 8) and RRD with PVR grade D (n = 4). Surgical procedures, clinical outcomes, and complications were documented.

RESULTS

Patients were followed for 9.75 ± 1.60 months. Each eye received 2.75 ± 1.22 hAM patches (mean area: 3.37 ± 1.51 cm 2 ). Two eyes (Cases 1 and 2) with small and regular retinal defects achieved full hAM coverage and retinal reattachment without significant PVR. Ten eyes with extensive defects could not achieve complete coverage of the exposed retinal pigment epithelium. In five eyes (Cases 3-7), the hAM patches covered the most exposed retinal pigment epithelium and retinal edge, but PVR on hAM surface caused hAM-traction of retina, leading to recurrent detachment in three eyes. In the other five eyes (Cases 8-12), a hAM-retina gap was maintained and prevented retinal interference from hAM contraction. Visual acuity improved significantly from 2.40 ± 0.25 LogMAR (Snellen: 20/5,023) to 1.43 ± 0.60 LogMAR (Snellen: 20/533) ( P = 0.003).

CONCLUSION

Human amniotic membrane patch-assisted vitrectomy is a promising strategy for managing complex RRD with advanced PVR. When complete coverage of the exposed retinal pigment epithelium is not feasible, maintaining a hAM-retina gap reduces postoperative traction and improves anatomical/functional outcomes.