Application of A “Sandwich” Technique For Large-Sized Human Amniotic Membrane Patching-Assisted Vitrectomy in Complex Rhegmatogenous Retinal Detachment

Purpose: To report a “sandwich” technique for covering extensively exposed retinal pigment epithelium using large-sized human amniotic membrane (hAM) patches during vitrectomy. Methods: The study examined six complex cases of rhegmatogenous retinal detachment after open globe injury, using a large hAM to cover exposed retinal pigment epithelium during vitrectomy with the “sandwich” technique. Data were collected preoperatively and during follow-up for at least six months. Results: In vitrectomy, a “sandwich” of perfluorocarbon liquid, fluid, and air tamponade was formed in the vitreous cavity. All eyes achieved full retinal pigment epithelial coverage, with no intraoperative complications detected. On average, 2.83 ± 1.33 hAM pieces were used, covering an area of 3.53 ± 1.50 cm 2 . Silicone oil tamponade was used in all eyes. During postoperative follow-up, none of the eyes developed postoperative proliferative vitreoretinopathy. Six months later, all patients had successful retinal reattachment, with silicone oil removed from four eyes. Mean best-corrected visual acuity improved from 2.3 ± 0.25 logarithm of the minimum angle of resolution (mean Snellen:20/3990) to 1.42 ± 0.56 logarithm of the minimum angle of resolution (mean Snellen: 20/526) 6 months after surgery ( P = 0.006). No cases of endophthalmitis or hAM rejection were observed during follow-up. Conclusion: The “sandwich” technique can safely cover exposed retinal pigment epithelium with single or multiple large-sized hAM patches, inhibit postoperative proliferative vitreoretinopathy, and improve the success rate of surgery in patients with complex rhegmatogenous retinal detachment.