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Purpose: To analyze anatomical and functional outcomes of cryopreserved human amniotic membrane (hAM) transplant in refractory macular hole (MH) surgery, present retinal layers structure after MH closure, identify visual acuity improvement determinants and complication rate., Methods: Prospective and interventional case series including seventeen patients: 13 refractory and 4 chronic (8, 15, 18 and 30-years) MH. All patients underwent vitrectomy, hAM subretinal transplant, tamponade and positioning. Complete ophthalmological examination, axial length, best-corrected visual acuity, retinography, optical coherence tomography (OCT) and autofluorescence were recorded., Results: Mean follow-up was 31 months (range 6-53). Mean LogMAR visual acuity (1.71 ± 0.42) improved significantly (1.13 ± 0.41) (P < 0.001). Patients with better baseline BCVA ended up with better final BCVA (P = 0.018). Mean MH minimum linear diameter was 831 ± 252 μm and base diameter was 1409 ± 358 μm. MH closed in all patients. Transitory ocular hypertension in one patient and transient vitreous cavity haemorrhage in another were the only postoperative complications. OCT matched scans showed plug integration and inner retinal layers rearrangement. MH size did not correlate with final BCVA. Autofluorescence showed no developing atrophy signs during long-term follow-up., Conclusion: Cryopreserved human amniotic membrane transplant may be a valuable approach to achieve macular hole closure and visual acuity improvement in refractory MH., Key Messages: What is known Human amniotic membrane transplantation is a recent surgical technique for refractory, chronic or extra-large macular holes. This surgical procedure has a shallow learning curve, high macular hole closure rate, does not require silicone oil tamponade and has very low complication rate. What is new Subretinal amniotic membrane transplant technique was successful at closing all patients' macular holes and improving visual acuity. Concerning final visual acuity predictors neither preoperative characteristics, namely the macular hole size or duration, etiology, lens status or axial length, nor surgical procedure modifications such as flap shape or tamponade lead to different outcomes. Our series included patients with refractory macular holes due to failed extended ILM peeling, failed inverted flap technique, failed autologous retinal transplant and failed epiretinal amniotic membrane transplant suggesting the technique's effectiveness in challenging refractory cases., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To report outcomes of re-vitrectomy using light silicone oil (SO) tamponade for persistent macular holes (MHs)., Methods: We reviewed cases of patients with full-thickness MHs that underwent pars plana vitrectomy (PPV) with air/gas and were re-vitrectomized using light SO tamponade after primary non-closure (persistent MHs). Outcome measures included anatomic closure rates and patterns confirmed by optical coherence tomography (OCT) and changes in best-corrected visual acuity (BCVA)., Results: A total of 42 eyes of 41 patients with unsuccessful primary PPV with air/gas were included. After re-vitrectomy with light SO (1000-centistoke), 29 (69%) eyes demonstrated type 1 closure without neurosensory defects in OCT scans, whereas 9 eyes (21%) showed type 2 closure with persisting neurosensory defects. Available data (n = 21) showed a significant mean improvement of BCVA from 0.99 logMAR (SD 0.25, range 0.7-1.3) preoperatively to 0.74 logMAR (SD 0.42, range 0.2-1.5) postoperatively (p = 0.035)., Conclusion: The treatment of persistent MHs with PPV and light SO tamponade resulted in high closure rates., (© 2023. The Author(s).)

Purpose: This study aims to analyze the success rate and functional outcome after revision surgery of persistent idiopathic full-thickness macular holes in a large patient cohort and to identify the optimal tamponade strategy and the value of new adjunctive manipulation techniques for persistent macular hole (pMH) closure., Methods: Retrospective, comparative, non-consecutive case series of all revisional surgeries for idiopathic pMH between 2011 and 2019 at the Eye Clinic Sulzbach were identified. Of 1163 idiopathic MH surgeries, 74 eyes of 74 patients had pMH. Of those, group 1 (n = 38) had vitrectomy with tamponade alone (20% sulfur hexafluoride gas, 15% hexafluoroethane gas, silicone oil 5000, Densiron®), while group 2 (n = 36) included tamponade with adjuvant manipulation (internal limiting membrane (ILM) translocation, subretinal fluid injection, epiretinal amniotic membrane, free retina graft, or autologous blood). Main statistical outcomes were anatomic closure rate, visual acuity (VA), minimum linear diameter (MLD), and base diameter (BD)., Results: Overall total anatomical success rate was 81.1% and mean VA improved 3.5 lines from LogMAR 1.03 ± 0.30 to 0.68 ± 0.38 (p < .001). Preoperative MLD or BD had no effect on total anatomic success (p = 0.074, p = 0.134, respectively). When comparing the two groups, slightly better anatomic success rates were achieved in group 1 (84.2%) compared to that in group 2 (77.8%) (p = 0.68). Final VA in group 1 (LogMAR 0.67 ± 0.39) outperformed group 2 (LogMAR 0.86 ± 0.38) (p = 0.03)., Conclusions: Revisional surgery for persistent idiopathic MH with tamponade alone had comparable anatomical closure but better VA outcomes, compared to tamponade with adjuvant manipulation., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)