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Presentation type	E-poster
Title	Subretinal Amniotic Membrane Graft for a Refractory Giant Full-Thickness Macular Hole

Purpose	To describe an alternative surgical approach using a human amniotic membrane (AM) graft for the management of a refractory giant full-thickness macular hole (FTMH).
Methods	A 74-year-old patient with a history of ocular trauma and longstanding decreased vision in the left eye presented with a chronic stage 4 FTMH. Baseline best-corrected visual acuity (BCVA) was 1/10. Initial pars plana vitrectomy with internal limiting membrane peeling and 20% SF6 tamponade resulted in persistence of the FTMH, measuring approximately 1000 µm at 1-month follow-up. During a second surgery, an inverted ILM flap was attempted but detached during fluid-air exchange; subretinal AM graft implantation with 20% SF6 tamponade was subsequently performed instead.
Results	Postoperative course after the second surgery was as follows: on day 1, the graft was correctly positioned and visual acuity was hand motion. At 1 week, OCT showed macular hole closure with the graft in a subretinal position and residual subretinal fluid; BCVA was 1/10. At 1 month, OCT confirmed sustained hole closure, stable graft position, and complete resolution of the subretinal fluid, with BCVA of 1/10.
Conclusion	Refractory FTMH occurs in a subset of cases despite primary vitrectomy with ILM peeling and gas tamponade, which achieves closure in most patients. Several rescue techniques have been proposed for these complex cases, including the inverted ILM flap, autologous retinal transplantation, and amniotic membrane grafting. In this case, subretinal AM grafting achieved anatomical closure of a refractory giant FTMH that had not responded to primary surgery, supporting its role as one of the available alternatives when conventional options are unsuccessful.
Conflict of interest	No

Authors 1

Last name	RIVERA PROAÑO
Initials	E
Department	Department of Ophthalmology, UCLouvain
City	Brussels

Authors 2

Last name	LARUELLE
Initials	G

Authors 3

Last name	COCHE
Initials	A