Incomplete Macular Hole Closure after Human Amniotic Membrane Plug Transplantation: Is Sulfur Hexafluoride Reinjection Necessary?

Purpose: To report a case of a patient with a Full-Thickness Macular Hole (FTMH) treated with a Pars-Plana Vitrectomy (PPV) and the positioning of a human Amniotic Membrane (hAM) plug. Methods: Patient was surgically treated with PPV, hAM plug implantation and SF6 (sulfur hexafluoride) as endotamponade. A complete ophthalmic examination and an Optical Coherence Tomography (OCT) were performed at every visit. Results: After surgery, the edges of hAM were elevated, folded and not perfectly outspread under the surrounding retinal layers, which were thickened and elevated, due to the presence of a persistent intraretinal oedema. A new surgery with reinjection of 20% SF6 was performed, but despite the closure of MH, neurosensory retina migration over the hAM plug was incomplete and macular edema persisted. Conclusion: hAM transplant is a valuable option for MH surgery. Plug dimension should be calibrated on MH diameter, and correctly spread under the edges of the hole itself. In cases of persistent macular hole, a new surgery with reinjection of 20% SF6 can be used to promote macular hole closure. Preoperative macular edema should be considered as a negative prognostic factor for MH closure.