Comparative analysis of macular microstructure in eyes treated with human amniotic membrane plug or internal limiting membrane transplant for Failed Macular Hole

Objective: To document comparative analysis of macular microstructures of eyes treated with autologous internal limiting membrane (ILM) transplant and human Amniotic Membrane (hAM) plug transplant for failed macular holes (FMH). Materials and Methods: Six patients who underwent successful surgeries for FMH were evaluated. The first three patients had undergone autologous ILM transplant, the others had undergone hAM plug transplant. They were examined using Adaptive Optics (AO) at baseline and at 6 months after surgery; OCT and OCT-Angiography were performed at 6 months. All images were evaluated morphologically; AO images were also analysed using the internal software. Results: Regarding the AO analysis in ILM-patients, the average cone density inside the lesion was 7684.44 ± 362.96 and the total spacing was 10.86 ± 0.97. In hAM-patients, the average cone density inside the plug area was 10197.9 ± 326.62 and the total spacing was 10.6 ± 0.72. It was not possible to analyse cone density in the area outside the lesion on any patients. All patients were also evaluated morphologically. OCT analysis in ILM-patients showed a subverted anatomical situation, while in hAM-patients revealed the regrowth of tissue layers and a resumption of foveal depression. OCT-Angiography analysis revealed an enlargement of the FAZ in ILM-patients and a fairly normal appearance and size of the FAZ in hAM-patients, in comparison to the fellow eye. Conclusions: Our findings require validation with a longer follow-up in a larger quantity of patients, but already suggest important differences in the cellular mechanism that underlies the tissue remodelling in these two techniques.