AMNIOTIC MEMBRANE GRAFT FOR THE TREATMENT OF LARGE REFRACTORY MACULAR HOLE

PURPOSE: Study off-label human amniotic membrane use outcomes for giant refractory macular hole closure. Materials and Methods: The study was performed at Lahore General Hospital, Lahore, over 52 months on patients who had undergone standard macular hole surgical procedures for treatment, but the hole failed to close. Refractory macular hole dimensions ranged from 824 mu m to 1,568 mu m. Before surgery, patients underwent slit-lamp examination, fundus photography, and optical coherence tomography for macular scan. Amniotic membrane graft (AMG) used in surgery was harvested from a human placenta 24 hours before. Before AMG application, enough internal limiting membrane peeling was performed to ensure perfect fitting and recovery. All holes were plugged with AMG and SF6 gas tamponade. Results: Twenty-nine patients, 20 men and nine women, were included in this study. Mean age of patients was 58 +/- 6. Patients had refractory holes of average 1,237.48 +/- 151.25 mu m. Post-op, 100% macular hole closure was achieved in all patients. Type 1 closure was found in patients (37.93%) who underwent AMG surgery within 3 months after primary surgical failure. Type 2 closure was found in patients (62.07%) who were operated on 3 months after primary surgical failure. Conclusion: Refractory macular holes treated by AMG with SF6 gas tamponade achieve anatomical Type 1 closure if performed within 3 months of primary surgical repair.