Use of Amniotic Membrane for MH Closure

In this chapter we shall analyze and focus our attention on the use of human amniotic membraneHuman Amniotic Membrane (hAM) when we are dealing with refractory macular holesRefractory macular holes or very large macular holesLarge macular hole (diameter > 800 μm). In these cases, hAM can be very useful to achieve the closure of these holes, and different types of membranes can be used today according to the surgeons’ choices and also the availability of tissues. We will examine several themes regarding the use of hAM in difficult cases and try to impart some technical advice to help manage hAM during vitrectomyVitrectomy. One of the main points to keep in mind is to have correct hAM management and surgical outcome, it is compulsory to have a specific equipment to perform this kind of surgery: some instruments cannot be exchanged with “similar” tools. Proper instruments, from the hAM preparation to its implant into the macular holeMacular hole, must be available in order to carry out good quality and safe surgery. Another consideration worth making is that, despite the great anatomical success we can achieve using the hAM in refractory macular holesRefractory macular holes or very large macular holesLarge macular hole, sometimes the visual acuity of this patients’ eyes, may not be very satisfactory. Hence our main recommendation to use hAM only when strictly necessary, and when a previous vitrectomyVitrectomy has already failed in macular holeMacular hole closure.