Amniotic Membrane Plug for Choroidal Hole and Epiciliary Membrane Removal: A Novel Surgical Rescue for Chronic Hypotony After Open Globe Injury.

PURPOSE: The purpose of this study was to describe a novel combined surgical technique using an amniotic membrane (AM) plug for choroidal hole closure and comprehensive epiciliary membrane removal to reverse chronic hypotony after open globe injury.

METHODS

The authors present a case of a 36-year-old man who developed severe hypotony and recurrent retinal detachment after multiple surgeries for open globe trauma. The surgical approach involved repeat pars plana vitrectomy, meticulous excision of circumferential epiciliary membranes, peripheral retinectomy, and transplantation of a dried AM plug into a large choroidal hole, followed by silicone oil tamponade. After anatomical recovery, silicone oil removal and a secondary AM patch over the exposed retinal pigment epithelium were performed.

RESULTS

The AM plug provided effective closure of the choroidal hole, prevented suprachoroidal silicone oil migration, and supported reattachment of the retina and choroid. The patient's intraocular pressure improved from 4 mmHg preoperatively to 10-11 mmHg postoperatively, with stable retinal anatomy and no recurrence of hypotony or epiciliary membranes during follow-up.

CONCLUSION

This combined surgical technique offers a promising option for complex, refractory hypotony after open globe injury with choroidal hole and proliferative vitreoretinopathy. Further studies are warranted to validate its efficacy and long-term outcomes in a broader cohort.