Patel Hares, Swiatek Kayla, Rivera-Zengotita Marie, Chen Jinghua
University of Florida, Department of Ophthalmology, USA.
University of Florida, Department of Pathology, Immunology, and Laboratory Medicine, USA.
Am J Ophthalmol Case Rep. 2024 Dec 24;37:102239. doi: 10.1016/j.ajoc.2024.102239. eCollection 2025 Mar.
Human amniotic membrane (hAM) grafts have been used to close persistent macular holes in recent years. The results from these surgeries are promising with improved closure rate and vision. However, there is lack of data for what happens to these membranes and how long the tissue should remain inside the patient's eyes. We report a case of hAM graft removal 6 months after closure of a persistent macular hole and the histopathology result of the removed hAM graft.
This is a report of a 57-year-old male patient that presented with hand motion vision, bullous, macula off rhegmatogenous retinal detachment in his right eye with multiple retinal holes and tears. Patient had 25G pars plana vitrectomy (PPV) with membrane peel and perfluoro-n-octane (PFO), silicone oil (SO) tamponade. After the first surgery, patient's retina reattached with a full thickness macular hole. Four months later, patient underwent PPV, SO removal, membrane peel and 20 % gas sulfur hexafluoride (SF6) tamponade. After the second surgery, the patient's macular hole remained open. Three months after the second surgery, we performed the third surgery with placement of dehydrated human amniotic/chorionic membrane (DHACM AMNIOFIX) over the macular hole and SO tamponade. Follow-up optical coherence tomography (OCT) showed the dehydrated amniotic/chorionic membrane (DHACM) integrated into the inner retina and the macular hole closed. However, the patient experienced obstruction of his central vision due to the graft. Six months after the third surgery, we removed the patient's silicone oil and the DHACM. After DHACM removal, the patient's vision improved to 20/80 and the OCT showed that the macular hole remained closed with restoration of macular layers. The histopathology examination of the removed DHACM did not show retinal tissue attachment.
This case shows the efficacy of dehydrated human amniotic membrane (hAM) graft to close a persistent full thickness macular hole and restore retinal layers. OCT imaging, prior to hAM removal, noted the hAM integration into the inner retina. In addition, we show that the graft can be removed after 6 months without obvious damage to the retina.
近年来，人羊膜（hAM）移植已被用于封闭持续性黄斑裂孔。这些手术的结果很有前景，封闭率和视力都有所提高。然而，对于这些羊膜在眼内的转归以及组织应在患者眼内保留多长时间，目前缺乏相关数据。我们报告了一例在持续性黄斑裂孔封闭6个月后取出hAM移植片的病例以及取出的hAM移植片的组织病理学结果。
本文报告了一名57岁男性患者，其右眼存在手动视力、大泡性、黄斑脱离的孔源性视网膜脱离，伴有多个视网膜裂孔和撕裂。患者接受了25G玻璃体切割术（PPV），联合膜剥除和全氟正辛烷（PFO）、硅油（SO）填充。首次手术后，患者视网膜复位，但黄斑裂孔仍为全层。4个月后，患者接受了PPV、SO取出、膜剥除及20%的六氟化硫（SF6）气体填充。第二次手术后，患者的黄斑裂孔仍未闭合。第二次手术后3个月，我们进行了第三次手术，在黄斑裂孔上方放置脱水人羊膜/绒毛膜（DHACM AMNIOFIX）并以SO填充。随访光学相干断层扫描（OCT）显示脱水羊膜/绒毛膜（DHACM）与视网膜内层融合，黄斑裂孔闭合。然而，患者因移植片出现了中心视力障碍。第三次手术后6个月，我们取出了患者的硅油和DHACM。取出DHACM后，患者视力提高到20/80，OCT显示黄斑裂孔保持闭合，黄斑各层恢复。取出的DHACM的组织病理学检查未显示视网膜组织附着。
该病例显示了脱水人羊膜（hAM）移植片封闭持续性全层黄斑裂孔并恢复视网膜各层的有效性。在取出hAM之前，OCT成像显示hAM与视网膜内层融合。此外，我们还表明，6个月后可以取出移植片，而不会对视网膜造成明显损害。
