Surgical Outcomes of Epiretinal Human Amniotic Membrane Transplantation for Refractory Macular Holes

Background/Objectives: Refractory macular holes (MH) that persist after conventional internal limiting membrane (ILM) peeling pose a significant surgical challenge. This study analyzed the anatomical and functional outcomes of epiretinal human amniotic membrane (hAM) transplantation in these patients. Methods: This retrospective study included 10 eyes of 10 patients with refractory MH. All patients underwent 25-gauge pars plana vitrectomy, epiretinal cryopreserved hAM transplantation, and C3F8 gas tamponade. The large hAM graft was placed over the macula with the chorion side facing the retina. Preoperative and postoperative best-corrected visual acuity (BCVA), optical coherence tomography (OCT) findings, and MH dimensions were recorded. Results: The mean follow-up period was 7 months (range 3–14 months). The mean preoperative minimum linear diameter and base diameter of the MHs were 715 ± 212 μm and 1114 ± 258 μm, respectively. Anatomical closure was achieved in all patients (100%). Postoperative OCT revealed rearrangement of the inner and other retinal layers in 7 out of 10 patients (70%), with partial restoration of the outer retinal layers. The mean logMAR BCVA improved significantly from 1.60 ± 0.37 preoperatively to 1.00 ± 0.45 postoperatively (p < .001). No graft dislocation, rejection, or other significant complications were observed. Conclusions: Epiretinal human amniotic membrane transplantation is an effective and safe surgical technique for achieving anatomical closure and functional improvement in refractory macular holes where conventional ILM peeling has failed.