Ferreira Magno A, Maia André, Machado André J, Ferreira Raquel E A, Hagemann Luiz Felipe, Júnior Pedro Hélio E Ribeiro, Rezende Flávio A
Universidade Federal de Uberlândia UFU - Federal University of Uberlândia, Uberlândia, Brazil.
Uberlândia Eye Hospital (HOLHOS), Av. Pará, 1720-Umuarama, Uberlândia, MG, 38405-320, Brazil.
Int J Retina Vitreous. 2021 May 8;7(1):38. doi: 10.1186/s40942-021-00308-6.
The purpose of the current study is to report the anatomical and functional results of off-label human amniotic membrane graft as primary intervention to repair large to giant macular holes and in reoperations when wide internal limiting membrane peeling was unsuccessful.
Retrospective chart review was carried out in five different centers to identify all cases that had undergone off-label human amniotic membrane graft for the treatment of large or failed macular holes (MH). Data collected included age, gender, other concomitant diagnosis, symptoms duration, lens status, number of previous surgeries, macular hole measurements (minimum and base linear diameters), mean post-operative follow-up (months), and pre- and post-operative best corrected visual acuity (BCVA). Main outcome measures were anatomical MH closure rates and final BCVA (in logMAR). Nonparametric Wilcoxon rank-sum test was used because the data was not normally distributed, a P values < 0.05 were considered statistically significant.
Nineteen eyes of 19 patients were identified and included in the study. Mean age was 66.21 ± 14.96 years and predominantly females (84%). All eyes had successfully closed MH with a single intervention with no recurrences during a mean of 9 ± 3.87 months follow-up. The median BCVA in logMAR preoperative was 1.30 ± 0.44 (0.80-2.0), approximately 20/400 on Snellen chart and the median BCVA in logMAR postoperative was 1.0 ± 0.72 (0.4-3.0) approximately 20/200 (p < 0.0001) with median of three lines of visual improvement.
The use of human amniotic membrane graft seems to be a viable and effective alternative for the treatment of large and persistent macular holes. However, further larger prospective controlled studies are necessary to confirm our preliminary results of this new surgical technique.
本研究的目的是报告将人羊膜移植用于修复大至巨大黄斑裂孔以及在广泛内界膜剥除失败后的再次手术时的解剖学和功能结果，此为一种非标签使用的主要干预措施。
在五个不同中心进行回顾性病历审查，以确定所有接受非标签人羊膜移植治疗大的或失败的黄斑裂孔（MH）的病例。收集的数据包括年龄、性别、其他伴随诊断、症状持续时间、晶状体状态、既往手术次数、黄斑裂孔测量值（最小和基底线性直径）、术后平均随访时间（月）以及术前和术后最佳矫正视力（BCVA）。主要结局指标为解剖学上黄斑裂孔闭合率和最终BCVA（以对数最小分辨角表示）。由于数据非正态分布，使用非参数Wilcoxon秩和检验，P值<0.05被认为具有统计学意义。
确定了19例患者的19只眼并纳入研究。平均年龄为66.21±14.96岁，以女性为主（84%）。所有眼睛均通过单次干预成功闭合黄斑裂孔，在平均9±3.87个月的随访期间无复发。术前对数最小分辨角的BCVA中位数为1.30±0.44（0.80 - 2.0），约为Snellen视力表上的20/400，术后对数最小分辨角的BCVA中位数为1.0±0.72（0.4 - 3.0），约为20/200（p<0.0001），视力平均提高了三行。
人羊膜移植似乎是治疗大的和持续性黄斑裂孔的一种可行且有效的替代方法。然而，需要进一步开展更大规模的前瞻性对照研究来证实这种新手术技术的初步结果。
