Human Amniotic Membrane Plug Successfully Closes Persistent Macular Holes

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The treatment had a high success rate, but yielded no significant improvements in visual acuity.

Using human amniotic membranes (hAM) to close macular holes may produce anatomical success, with a study published in Ophthalmology Retina showing a closure rate of 91%. However, the treatment did not yield significant improvement in visual acuity in patients with persistent or chronic macular holes. 

The investigators conducted a retrospective chart review of all consecutive patients with persistent or chronic macular holes between January 2018 and February 2021 at 2 Canadian tertiary care centers. Macular hole surgery with hAM was performed by 3 vitreoretinal surgeons. 

The primary outcome of the study was macular hole closure defined as complete plugging with hAM tissue on spectral domain-optical coherence tomography imaging. Secondary outcomes included visual acuity outcomes and complications.

Of 22 patients with persistent or chronic macular holes, 20 patients had complete hole closure, for a closure rate of 91%. The closure rate ranged from 67% to 100% according to the subtype of macular hole. 

The median preoperative visual acuity was 20/339. The investigators evaluated visual acuity between 2 to 6 months after surgery and at the final follow up visit at a median of 7 months (range, 2-27 months); they observed no statistically significant changes in visual acuity at either time point compared with preoperative levels (P =.99 and P =.85, respectively).

“Visual improvement in our study was lower than previous reports,” the researchers report. “Possible contributing factors include the number of visually significant complications and pending silicone oil or cataract removal, as there was a trend towards visual improvement if all these cases were excluded.”

Postoperative complications included subretinal silicone oil (5%), choroidal neovascularization (5%), atrophy (5%), and cystoid macular edema (9%).

Limitations of the study included the retrospective design and small sample size.

“The hAM plug technique resulted in a [macular hole] closure rate comparable to existing reports in the literature,” according to the study. “Given the limited visual acuity outcomes of this study, a note of caution on the use of this technique may be warranted pending larger prospective studies with head-to-head comparison groups.”


Bamberger MD, Felfeli T, Politis M, Mandelcorn ED, Galic IJ, Chen JC. Human amniotic membrane plug for chronic or persistent macular holes. Ophthalmol Retina. Published online January 17, 2022. doi:10.1016/j.oret.2022.01.006