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Treatment of complex macular holes using a large disc of trypan blue stained‐lyophilized amniotic membrane: a 10 cases series with 1‐year follow‐up
Author(s) -
Garcin Thibaud,
Gain Philippe,
Thuret Gilles
Publication year - 2021
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.20200031
Subject(s) - medicine , trypan blue , tamponade , vitrectomy , ophthalmology , macular hole , fundus (uterus) , surgery , visual acuity , chemistry , biochemistry , in vitro
Purpose Treatment of complex macular holes (MH) is challenging. The use of amniotic membrane (AM) has been described but is not yet codified, and we need to collect more cases. Aim To describe tips and tricks for the use of a large patch of lyophilized AM (lAM) in this indication. Methods Consecutive 10 cases series: two patients with severe MH‐induced rhegmatogenous retinal detachment (RRD), three with recurring RRD + persistant MH, five with persistant MH after inner limitant flap. Our IRB approved the study and all patients signed an informed consent. lAM (Visio Amtrix, TBF) was chosen because of its availability, easy handling, thinness and transparency. A 3‐ to 4‐mm diameter disc was trephined with a disposable punch, stained with 0.06% Trypan Blue (after a first failure due to poor visualization of an unstained lAM) and rinsed with BSS. Stained lAM were inserted through a 23G sclerotomy using a standard perfusion catheter and unfolded on top of the MH using a forceps and a backflush needle. Tamponade was done with gas (17% C2F6, Arceole; n = 6) or heavy silicone (Densiron 68, Fluoron; n = 4) depending of the case. Routine follow‐up was done for 12 months, including SD‐OCT (Spectralis, Heidelberg) and color fundus photography (CR2‐AF, Canon). Results Ten eyes of 10 patients of 62 ± 9 years with preoperative mean BCVA 1/80 (1.9 logMAR) and a mean minimal MH diameter of 942 ± 333 μ m underwent surgery. The blue staining disappeared within 15 days. Anatomic success occurred for all patients: six/10 were closed, four/10 had reduced diameter. BCVA improved in all cases. The five RRD were reattached without recurrence. Apart one failure (lAM left unfolded) with migration at day 1 and MH closed with central scar, no secondary displacement of the patch occurred. Conclusions A large patch of lAM seems a new method to cure complex MH in different situations. Trypan blue staining is, in our hand, absolutely necessary to allow correct positioning. Complete unfolding seems also required to allow good adherence over the MH.