Epiretinal implant of human amniotic membrane to treat highly myopic macular hole retinal detachments: A novel surgical technique.

PURPOSE: To describe a new surgical technique involving the use of a human amniotic membrane (hAM) epiretinal patch to treat a primary macular hole retinal detachment (MHRD) in a highly myopic patient. METHODS: A 60 years old highly myopic man was referred to our clinic with a diagnosis of MHRD in his right eye. The patient was pseudophakic, with a visual acuity of counting fingers at the baseline evaluation. Pars plana vitrectomy was performed, a small retinotomy was created at the inner margin of the staphyloma, and membrane blue dual was used to obtain an adequate peeling of the inner limiting membrane. Then, a 1.5 mm diameter circular hAM patch was obtained and positioned over the macular hole with the chorion layer settled over the retina. After a complete fluid-air exchange, 20% sulfur hexafluoride gas was used as endotamponade, and the patient was asked to remain face down for three days. RESULTS: Four weeks after surgery, optical coherence tomography (OCT) scan showed the hAM patch, visualized as a distinct hyperreflective layer well integrated with the retina. Nine months after surgery, the macular hole was closed, the retina reattached, the hAM patch was adherent to the retina, and the patient presented a best-corrected visual acuity improved to 0.7 logMar. No postoperative adverse events were registered during the follow-up. CONCLUSIONS: Epiretinal hAM implant could represent a novel surgical technique, feasible and easier compared to other current techniques used to treat MHRD in highly myopic patients.

Macular hole closure patterns: an updated classification.

BACKGROUND: The classification of macular hole closure patterns (MHCPs) currently relies on time domain OCT allowing only "open" and "closed" statuses or is based on inner foveal contour shape. Both classification types give no information on retinal layer reconstitution. Novel sophisticated surgical techniques lead to previously unknown MHCPs, outdating existing classifications and urging new ones. The purpose of the present study is to introduce a new classification allowing proper description of all MHCPs resulting from newer surgeries and based on the restoration of retinal layers. METHODS: Retrospective analysis of patients undergoing MH surgery with five different surgical techniques was performed. MHCPs were classified according to spectral domain optical coherence tomography (SD-OCT). Type 0: open MH (0A: flat margin, 0B: elevated, 0C: oedematous); type 1: closed MHs (1A: reconstitution all retinal layers; 1B interruption of the external layers; 1C interruption of internal layers); type 2: MH closed with autologous or heterologous filling tissue interrupting the normal foveal layered anatomy (2A: filling tissue through all layers; 2B reconstitution of normal inner retinal layers; 2C reconstitution of normal outer retinal layers; 2D H-shaped bridging of filling tissue). RESULTS: Closure rate was 95.2% (241/253). Surgical technique and vision correlated to closure pattern (p < 0.001). Type 1 MHCPs had the best post-operative visual acuity (VA) compared with type 2 and type 0 (p < 0.001). MHCPs 1A and 1C performed better than all others. MHCP at months 1 and 3 changed in 42/254 (16.5%) and remained stable in 212/254 (83.5%). Improvement in vision was higher in eyes with shifting closure pattern (0.57 ± 0.33 vs 0.51 ± 0.48 logMAR; p 0.021). CONCLUSION: MHCP classification based on retinal layer restoration properly comprises post-operative anatomic morphologies. MHCPs correlate the surgical technique and post-operative visual outcomes.

Manejo de quemadura ocular severa con implante de membrana amniótica / Severe ocular chemical injuries management with amniotic membrane implant

Objetivo: Las quemaduras oculares químicas con compromiso extenso de limbo (mayor del 50%) tienen mal pronóstico visual con manejo médico como única alternativa terapéutica; por lo que el propósito de este trabajo es evaluar el tratamiento temprano con el implante de membrana amniótica en cuanto a resultados anatómicos y funcionales en estos pacientes. Metodología: Estudio retrospectivo tipo serie de casos. Se presentan los resultados visuales en 9 ojos de 6 pacientes tratados en la Clínica de Oftalmología de Cali y el Hospital Universitario del Valle con quemadura ocular química grave a los que se les realizó implante precoz de membrana amniótica adjunto al manejo oftalmológico convencional. Resultados: Todos los pacientes tuvieron mejoría de la agudeza visual. El 87% de ellos lograron una agudeza visual mejor corregida (AVMC) de 20/30 o mejor. Ningún paciente desarrolló simbléfaron ni requirió trasplante heterólogo de córnea. Conclusiones: Los resultados presentados sugieren que el implante de membrana amniótica precoz adicional a la terapia médica, puede ser el manejo de elección en la fase aguda de quemaduras químicas extensas de superficie ocular (compromiso mayor del 50% de limbo), ya que mejora el pronóstico visual con respecto a la terapia médica como único manejo.

Purpose: Ocular chemical burns with extensive limbus involvement (greater than 50%) have poor visual prognosis with medical management as the only therapeutic alternative; So the purpose of this work is to evaluate if early treatment with amniotic membrane implant improves the anatomical and functional results in these patients. Methods: Retrospective study of a cases series. We present the visual results in 9 eyes of 6 patients treated at the Cali Ophthalmology Clinic and the Valle´s University Hospital with severe chemical ocular burns who underwent early amniotic membrane implantation added to conventional ophthalmologic management. Results: All patients had improvement of visual acuity. 87% of patients achieved a better corrected visual acuity (BCVA) of 20/30 or better. No patient developed simblefaron or required heterologous corneal transplantation. Conclusions: The results presented suggest that amniotic membrane implantation in addition to medical therapy could be the management of choice in the acute phase of extensive ocular surface chemical burns (involvement greater than 50% of limbo), since it improves the visual prognosis with respect to medical therapy as sole management.