OSLI Retina

January 2020

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50 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ S U R G I C A L R E V I E W ■ Amniotic Membrane Plug to Promote Chronic Post-Traumatic Macular Hole Closure Tomaso Caporossi, MD; Bianca Pacini, MD; Lorenzo De Angelis, MD; Stanislao Rizzo, MD BACKGROUND AND OBJECTIVE: To assess the ef- ficacy of the amniotic membrane (AM) to close a chronic post-traumatic macular hole (PTMH). PATIENTS AND METHODS: A patient affected by PTMH derived from a blunt trauma occurring 25 years ago who had never undergone surgery was referred to the authors' clinic. He underwent a pars plana vitrectomy (PPV) with an AM plug implant in the macular hole (MH) and 20% sulfur hexafluo- ride (SF 6 ) as endotamponade. The patient was posi- tioned face-down for the first 5 postoperative days. RESULTS: Prior to surgery, the MH displayed an internal diameter of 971 µm, and the preoperative best-corrected visual acuity (BCVA) was 20/400 (1.3 logMAR). Optical coherence tomography (OCT) showed a chronic MH with flat margins. Ten days after surgery, BCVA was 20/200 (1 logMAR), and the MH was closed. Three months after sur- gery, BCVA improved to 20/100 (0.7 logMAR), and the MH remained closed. No adverse events were registered during the follow-up period. CONCLUSION: AM plug seems to be useful to close chronic PTMH with good BCVA recovery. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:50-52.] INTRODUCTION A post-traumatic macular hole (PTMH) is a com- plication of ocular trauma first described by Her- man Knapp in 1869 1 and represents about 10% of all full-thickness macular holes (FTMHs). They are produced by a sudden increase in tangential traction vector forces in the vitreous cortex and exerted on the macula. 2 Numerous reports in literature show cases of spontaneous closure of the PTMH in a period of 2 weeks to 4 months after the trauma, with a percentage between 44% and 67%. 3-7 When PTMH does not close spontaneously, pars plana vitrectomy (PPV) with fluid-gas exchange and internal limiting membrane (ILM) peeling remains the gold standard of treatment, with a percentage of success of 94% to 96%, 8,9 and a mean final best-cor- rected visual acuity (BCVA) reported of 20/40. In cases of large chronic macular hole (MH), vari- ous adjuvant therapies include transforming growth factor-beta-2, 10 autologous platelets concentrate, 11 bi- ological tissue as autologous retinal graft, 12 or ILM as inverted flap 13 or autologous transplantation. 14 We report the first use of the human amniotic membrane (AM) plug to close a large, chronic PTMH. PATIENTS AND METHODS A 50-year-old male was referred to our clinic for a 25-year history of a PTMH in the right eye after sustaining blunt trauma from a work-related injury. BCVA was 20/400 in the affected eye and 20/20 in the fellow eye. The patient was phakic in both eyes with mild cataract opacification. Fundus examination revealed a FTMH with posterior vitreous detachment. From the Department of Translational Surgery and Medicine, Ophthalmology, University of Florence, Careggi, Florence, Italy. Originally submitted February 25, 2019. Revision received July 11, 2019. Accepted for publication July 29, 2019. The authors report no relevant financial disclosures. Address correspondence to Tomaso Caporossi, MD, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; email: tomaso.caporossi@gmail.com. doi: 10.3928/23258160-20191211-07

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