Lyophilized Human Amniotic Membrane Grafts Promote Macular Hole Closure

Autologous blood clot-assisted lyophilized human amniotic membrane (LhAM) grafts promote closure of macular holes (MH) in eyes that previously underwent vitrectomy with internal limiting membrane (ILM) peeling, according to research published in Clinical Ophthalmology. 

Researchers evaluated 12 eyes with unclosed MH from previous surgery of 12 patients (7 women and 5 men; mean age, 63.3±7.9 years) in a prospective, interventional, and consecutive case series. The mean minimum diameter of the MH was 641.7±245.9 μm, and the mean diameter of the base was 876.0±318.2 μm. In all cases, ABC-assisted LhAM graft was used to cover the MH. The main clinical outcomes were best-corrected visual acuity (BCVA), closure of the MH, and outcome of LhAM graft.

The study shows the  lyophilized human amniotic membrane graft was maintained in position in 10 eyes, resulting in a MH closure rate of 83.3%. In 2 eyes, the  lyophilized human amniotic membrane graft was dislocated, and the MHs remained unclosed. 

Patients demonstrated significantly improved mean BCVA, from 1.47±0.58 logMAR preoperatively to 1.17±0.60 logMAR postoperatively (P <.05). 

During the final follow-up visit (between 18-36 months), the  lyophilized human amniotic membrane grafts remained attached to the retinal surface in 9 of 12 eyes (75%). 

“It has been found that for eyes suffering persistent MH accompanied with ILM peeling in prior operation, especially for those eyes affected with high myopia, because of difficulty in ILM capturing, as well as inappropriate sizes and loss of the ILM with fluid, reoperation with the residual fragments of ILM insertion could be technically challenging,” according to the study authors. “The hAM could serve as an optimal substitute of the ILM, because of the presence of collagens IV and VII, fibronectin, laminins and hyaluronic acid in its basement membrane.”

Limitations of the study included the limited number of cases, lack of a control group, use of lyophilized (not fresh) grafts only, and a limited follow-up duration.