Purpose: To describe the triple S technique for aiding the visualization (staining), preparation (sizing), and placement (sliding) of human amniotic membrane grafts in cases of refractory macular holes (MHs). Methods: Brilliant blue–green dye was used to stain the graft before insertion for improved visualization and to aid in its orientation. Preoperative optical coherence tomography–based sizing of the graft was performed, and a dermal trephine was used to fashion the graft according to size. Once placed in the eye, the graft was positioned by bimanually sliding it into the MH using a nitinol loop and a Tano brush. Results: Seven eyes of 7 patients had repair of a refractory MH. Anatomic closure was successful in all patients with no postoperative displacement or dislodgement of the graft. The mean logMAR (±SD) visual acuity was 1.80 ± 0.4 preoperatively and 1.27 ± 0.6 at the final follow-up. Conclusions: The triple S technique provided adequate visualization, sizing, and placement of amniotic membrane grafts in cases of refractory MHs. This modification may help reduce the learning curve associated with this technique.
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