Amniotic Membrane Coverage for Intractable Large Macular Holes: A First Report in Japanese Patients

Background and Objective In recent years, the success rate of treating refractory macular holes with internal limiting membrane (ILM) inversion has significantly increased. However, closure remains challenging for large macular holes even after ILM inversion. Here, we report the evaluation of amniotic membrane coverage for intractable large macular holes. Patients and Methods: We retrospectively analyzed five eyes of five patients (3 males, 2 females; mean age 70.6 ± 13.3 years) with stage 4 macular holes that did not close after ILM inversion performed at our institution from June 2022 to May 2024 and were followed up for more than 6 months. Preoperative macular hole dimensions were assessed using optical coherence tomography (OCT). Surgery was performed using 27-gauge transconjunctival vitrectomy without ILM peeling. Two layers of amniotic membrane were placed in the macular center using a double-headed technique under air tamponade, followed by complete vitreous fluid exchange with 10% sulfur hexafluoride gas. Postoperative outcomes were evaluated using OCT for macular hole closure and visual function assessment 6 months postoperatively. Results: The preoperative macular hole size was 1072.200 ± 189.043 μm, and the preoperative logMAR visual acuity was 1.222 ± 0.278. All macular holes closed postoperatively, with a postoperative logMAR visual acuity of 0.320 ± 0.110. Conclusion: The amniotic membrane coverage technique for intractable large macular holes was found to be an effective method contributing not only to macular hole closure, but also to visual acuity improvement postoperatively.