Human Amniotic Membrane: A Seal for Complex Retinal Detachments

Objectives: To evaluate the efficacy of human amniotic membrane (hAM) transplantation for complex retinal detachments (RD). Materials and Methods: A retrospective analysis of consecutive patients who underwent vitreoretinal surgery with hAM transplantation for complex RD was conducted. The indications included high myopic macular hole (MH)-associated RD (n=5), traumatic large macular tears (n=4), combined RD with MH due to cicatricial retinopathy of prematurity (n=2) and severe retinitis (n=1), and morning glory syndrome (n=1). Surgical procedures, anatomical and functional results, and complications were noted. Results: Thirteen eyes of 13 patients with a median age of 7 years (range, 0-65 years) were included. The follow-up was 15 months (range, 6-30 months). All eyes achieved MH sealing. Sealing occurred after a single surgery in 75% of eyes, while 25% required a second surgery due to hAM contraction/dislocation. The retina was attached and silicone oil could be removed in 92% of eyes during follow-up. The mean logarithm of the minimum angle of resolution visual acuity increased from 2.08 +/- 0.49 to 1.78 +/- 0.70 (p=0.07). Optical coherence tomography showed good integration of the hAM grafts with the retina, albeit without discernible retinal layer differentiation in any case. Conclusion: Amniotic membrane grafting appears to be promising for anatomical sealing of MHs and posterior retinal tears in complex RDs such as those associated with degenerative myopia, severe trauma, tractional membranes, and retinal shortening, where conventional surgical techniques are likely to fail. Further research is needed to clarify the regenerative potential and functional capacity of hAM grafts in severe retinal pathologies.