Human Amniotic Membrane plug to restore Age related Macular Degeneration photoreceptors' damage.

OBJECTIVE: and purpose: Age-related macular degeneration (AMD) is the leading cause of legal blindness in adults of 65 years old and older. Choroidal neovascularization (CNV) can complicate AMD and lead to severe visual acuity reduction. Despite the several treatments available, if the retinal pigmented epithelium (RPE) is damaged, we have to cope with the impossibility to restore an acceptable visual acuity using only medical treatments. DESIGN: this is a prospective, consecutive, interventional study. SUBJECTS: we included eleven patients affected by age-related macular degeneration, six patients were affected by choroidal neovascularization and five by geographic atrophy. METHODS: all the patients underwent a pars plana vitrectomy with subretinal implant of human amniotic membrane (hAM) to induce photoreceptor regeneration and partial visual acuity restoration. MAIN OUTCOMES AND MEASURES: the primary study outcome was the visual acuity improvement. Secondary outcomes were multimodal imaging results. RESULTS: Mean preoperative best corrected visual acuity (BCVA) was 20/2000 (2 logMAR), all the patients had a BCVA of counter finger or less. Mean final BCVA was 20/400 (1.31 logMAR), ranging from 20/2000 to 20/100 (2-0.7 logMAR). OCT Angiography scan was used to measure the retinal vascularization in the treated eye compared with the fellow eye. A high correlation between BCVA and Deep Vascular Density was evidenced. Adaptive optics was evaluated over the retinal area where the highest functionality was observed, using microperimetry. The images showed a possible photoreceptors presence over the hAM membrane. CONCLUSION: This work supports the feasibility and safety of the hAM to promote a partial retinal function restoration six months after surgery with a visual acuity improvement. The advanced diagnostic helps to understand the interaction between the hAM and photoreceptors and suggest that photoreceptor regeneration may occur.