Human Amniotic Membrane Use in Macular Hole Surgery

Abstract

Purpose: To evaluate the heterogeneity and reporting of human amniotic membrane use for full-thickness macular hole (FTMH) repair. Methods: This systematic review, registered on PROSPERO (CRD420251112018) and following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, used PubMed, Embase, and Scopus to search for English studies using human amniotic membrane for FTMH published before July 24, 2025. Risk of bias was assessed without formal evidence grading. Extracted data included macular hole type, surgical technique, graft type, size, and orientation, tamponade and patient positioning, definition of closure and closure rate, visual acuity improvement, and complications. Results: Sixty-three studies utilizing various techniques were included. Thirty-nine studies (61.9%) used a macular hole plug, 16 (25.4%) an epiretinal patch, 2 (3.2%) a double-layer technique, 5 (7.9%) reported using more than 1 technique, and 1 study did not specify the placement technique. The graft type was unspecified in 43% of studies, 30% did not describe the size or shaping of the graft, and the graft orientation was unreported in 46%. Thirty-three percent of studies employed multiple different tamponades, and 41% of studies omitted postoperative patient positioning. The type of anatomic closure was not defined in 70% of studies, and few applied standardized optical coherence tomography–based classification systems. Improvement in best-corrected visual acuity was reported in 81% of studies, and 56% cited no significant complications. Conclusions: This review highlights inconsistencies in how human amniotic membrane–assisted macular hole surgeries are described and reported. As transplantation with human amniotic membrane becomes more widely adopted, standardized reporting will help to compare techniques and assess differences in anatomic and functional outcomes.