Refractory macular hole surgery with amniotic membrane transplant functional assessment

To evaluate refractory macular hole (MH) surgery with amniotic membrane transplant functional outcomes. Prospective study over a five-year period. Nineteen patients with full-thickness macular hole (15 refractory MH and 4 chronic ≥ 8 years MH) were included. All patients underwent vitrectomy, cryopreserved amniotic membrane subretinal graft, tamponade and positioning. Functional outcomes were assessed using best-corrected visual acuity, M-CHARTS™ and mfERG (P1 and N1 waves amplitude and implicit time in five rings and ratios) preoperatively, at 3- and 12-months follow-up. Optical coherence tomography was also performed for structure-function analysis. Mean follow-up was 45 months (range 15–68). Mean MH minimum linear diameter was 819 ± 242 μm and base diameter was 1387 ± 346 μm. After surgery, MH closed in all patients. Mean logarithm of the minimum angle of resolution (logMAR) visual acuity improved significantly from 1.70 ± 0.40 to 1.12 ± 0.39 (p < 0.001), mean first ring P1 amplitude, P1 implicit time, N1 amplitude and ratio 2 increased significantly (ß = 19.82, p = 0.029), (ß = 6.72, p = 0.033), (ß = 10.76, p = 0.007) and (ß = 0.836, p = 0.011), respectively. Foveal peak improved in 60% patients, one third presenting eccentric positioning. Visual acuity, metamorphopsia and mfERG improvements postoperatively suggest that amniotic membrane graft may be a useful tool to achieve refractory macular hole closure and enhanced functional outcomes.