Efficacy and Safety of Amniotic Membrane Transplantation in Vitrectomy for Extra-large or Long-standing macular holes: A Prospective Clinical Study Exploration of macular hole treatment.

Abstract

To evaluate the efficacy and safety of amniotic membrane transplantation during vitrectomy for extra-large or long-standing macular holes. A single-center, noncomparative prospective observational study included 8 eyes from 8 patients with extra-large or long-standing macular holes (6 recurrent, 2 primary). All patients underwent vitrectomy with amniotic membrane transplantation over the macular hole. Baseline assessments included best-corrected visual acuity(BCVA), optical coherence tomography (OCT), multifocal electroretinography (mfERG), macula microperimetry, and adaptive optics (AO) imaging to evaluate photoreceptor cells on the graft surface. Outcome measures were recorded during follow-up. All 8 eyes achieved macular hole closure during the follow-up period, with 1 case developing amniotic membrane graft displacement that did not cause macular hole recurrence. After the follow-up ended, at 18 months postoperatively, this case experienced a recurrence of the macular hole due to rhegmatogenous retinal detachment(mean follow-up: 14.3 ± 8.1 months). Baseline macular hole diameter was 825.2 ± 265.9μm. BCVA improved in 4 eyes (50%) and stabilized in others. mfERG 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 5 eyes (62.5%), with enhanced 2° and 4° fixation rates. Absolute scotomas resolved post-treatment. AO imaging confirmed photoreceptor cell attachment on the graft surface. No adverse events related to the amniotic membrane were observed. Amniotic membrane transplantation facilitates extra-large or long-standing macular hole closure, improves macular function, and demonstrates favorable safety. This approach may enhance photoreceptor recovery, supporting its clinical utility.