The human amniotic membrane in vitreoretinal surgery: applications, outcomes and limitations

The human amniotic membrane (hAM) has gained recognition as a valuable biological adjunct in vitreoretinal surgery, with its applications rapidly expanding since its initial use for macular holes (MHs). We examine the development and present applications of hAM in vitreoretinal surgery, assessing its use in treating various pathological conditions such as MHs, retinal detachments (RDs) with proliferative vitreoretinopathy (PVR), high myopia-associated MHs with posterior staphyloma, optic pit maculopathy, and other vitreoretinal disorders. We evaluate the differences between cryopreserved and lyophilized hAM preparations and compares outcomes of subretinal and epiretinal placement techniques. Evidence from the literature suggests that hAM serves as an important therapeutic option for complex vitreoretinal conditions, demonstrating anatomical success rates ranging from 80% to 95% across various indications. The strongest evidence indicates its efficacy in refractory MHs (closure rates 85-100%), myopic macular holes associated with posterior staphyloma (86-92%), and complex RDs with proliferative vitreoretinopathy (76-92%). Both cryopreserved and lyophilized preparations exhibit efficacy; however, their surgical handling characteristics and biological properties vary, which may affect outcomes in particular indications. Current evidence suggests that subretinal positioning is typically used for large, highly myopic, or refractory MHs, whereas epiretinal placement is preferred in cases of PVR and optic pit maculopathy. While the results are promising, it is essential to standardize techniques, obtain long-term follow-up data, and conduct randomized controlled trials comparing hAM to conventional approaches to establish definitive recommendations.