Applications of Human Amniotic Membrane Patching Assisted Vitrectomy in the Management of Postoperative PVR in Complex Retinal Detachments

Abstract

Human amniotic membranes (hAMs) are extraembryonic tissues currently employed in the treatment of many ocular and systemic diseases. Several reports indicate that hAMs can suppress the signaling pathway of tissue growth factor beta (TGF-β), a cytokine that plays a major role in the pathogenesis of proliferative vitreoretinopathy (PVR) through the induction of epithelial-mesenchymal transition (EMT) in exposed retinal pigmented epithelium (RPE) cells. The present study was conducted to evaluate the efficacy of a modified vitrectomy procedure (hAMP-V) involving the extensive coverage of exposed RPE with hAM patches to prevent postoperative PVR in a series of 15 cases of retinal detachment complicated by severe preoperatory PVR. The primary outcome was to assess the rate of successful retinal reattachment of a single hAMP-V procedure at 6 months from silicone oil removal. Secondary outcomes included the collection of intraoperative data concerning the quantity, size, and scope of hAM patches, and the assessment of postoperative improvements in mean LogMar BCVA at 3 and 6 months. Successful retinal reattachment was obtained in 14 out of 15 eyes (93.3%). Surgical failure due to major recurrence of PVR occurred in 1 out of 15 eyes (6.7%). Postoperative improvements in mean LogMar BCVA were statistically significant (p < 0.05, paired t-test). No intraoperative and postoperative adverse effects were reported. The study helped to refine the surgical technique while also offering cues for future improvements.

Proliferative Vitreoretinopathy: A Reappraisal

“…Recently, Caporossi et al [ 142 ] evaluated the efficacy of a modified vitrectomy procedure involving the coverage of exposed RPE in retinal breaks and retinotomy with human amniotic membrane (hAM) patches to prevent postoperative PVR in a series of 15 cases of retinal detachment complicated by severe preoperatory PVR, assuming that hAM can suppress the TGF-β pathway in a selected population of cells involved in the pathogenesis of PVR, including fibroblasts, macrophages, and particularly RPE cells.…”

Epiretinal Amniotic Membrane Influences the Cellular Behavior of Profibrotic Dedifferentiated Cells of Proliferative Vitreoretinopathy In Vitro

“…However, compared to atrophic retinal diseases, PVR is caused by a severe fbrotic cell response to retinal detachment [11,12]. Despite the diferent pathogenesis, frst intraocular implantations of AM in case series with complex retinal detachments at high risk for PVR development also indicated a benefcial efect [13,14]. Other studies showed that AM may promote wound healing through fbroblast proliferation and induction of migration and expression of the extracellular matrix [15].…”