Enhancing Internal Limiting Membrane Inverted Flap Outcomes With Amniotic Solution for Chronic and Large Macular Holes

Purpose: This study assesses the effectiveness of a modified inverted internal limiting membrane flap technique combined with human amniotic membrane solution for treating large, chronic, and idiopathic conditions. Methods: Fourteen eyes from 14 patients underwent pars plana vitrectomy with a temporal internal limiting membrane flap technique and hAM application. Two methodologies for hAM preparation were compared: the direct injection of an hAM suspension and a refined method that used a vitrectomy probe to produce a homogeneous hAM solution. All eyes were tamponed with 20% sulfur hexafluoride. Results: Postoperative outcomes showed significant improvements in best-corrected visual acuity and successful macular hole closure in all cases. The homogeneous hAM solution yielded superior anatomical and functional outcomes compared with the initial suspension method. It also showed better retinal layer integration without any adverse effects like displaced fragments or visual disturbances. Conclusion: This study highlights hAM solution as a promising supplement in macular hole surgery, enhancing flap stabilization and retinal regeneration. Larger studies are needed to confirm its long-term efficacy and safety.