{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T23:10:34Z","timestamp":1789081834333,"version":"build-2803163510"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":79,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Medical Council of Thailand Research Grant"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Retin Vitr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Large idiopathic full-thickness macular holes (FTMH) with minimum diameter\u2009&gt;\u2009400\u00a0\u03bcm carry surgical success rates of approximately 60% with standard vitrectomy and gas tamponade. Novel biologic scaffolds have improved closure rates but are limited by intraoperative handling challenges. We describe a surgical technique using thermosensitive injectable decellularized human amniotic membrane (dAM) hydrogel as an intraocular scaffold for large FTMH, and illustrate its feasibility and safety in a first-in-human application with four-month anatomical, functional, and electrophysiological outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Surgical technique<\/jats:title>\n                    <jats:p>A 62-year-old man with a Gass stage 4 idiopathic FTMH (minimum diameter 572\u00a0\u03bcm) and preoperative BCVA of 20\/200 underwent combined phacoemulsification and 25-gauge pars plana vitrectomy (PPV) with ILM peeling. Following fluid-air exchange, dAM hydrogel (10\u00a0mg\/mL, thermosensitive, prepared by detergent decellularization and pepsin solubilization) was injected via a 25-gauge soft-tip cannula, followed by SF6 gas tamponade. Pre-clinical biocompatibility was confirmed by CCK-8 assay and transwell invasion assay prior to clinical use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>At one month, SD-OCT confirmed complete Type 1 anatomical closure and BCVA improved to 20\/80. At four months (day 121), BCVA further improved to 20\/40\u2009+\u20091 (logMAR 0.30), with no metamorphopsia, IOP 12.7 mmHg, and sustained Type 1 closure with progressive ellipsoid zone (EZ) reconstitution on OCT. Multifocal ERG (103 segments) confirmed measurable foveal P1 responses (Ring 1: 34.19 nV\/deg\u00b2) with normal central N1 implicit time (40.2 ms; normal range 36.8\u201346.4 ms). No intraocular adverse events occurred at any time point.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This injectable dAM hydrogel scaffold technique is a feasible, instrument-sparing method for large FTMH repair, achieving stable Type 1 closure with progressive visual and electrophysiological recovery over four months. mfERG evidence of preserved foveal photoreceptor function supports its safety. Prospective comparative evaluation is ongoing (ClinicalTrials.gov: NCT06433284).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT06433284 (MACROHOLE trial). Registered April 2024.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40942-026-00893-4","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T17:26:37Z","timestamp":1782321997000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["First-in-human application of decellularized human amniotic membrane hydrogel as an injectable intraocular scaffold for large idiopathic full-thickness macular hole closure: four-month clinical outcomes"],"prefix":"10.1186","volume":"12","author":[{"given":"Jakkrit","family":"Juhong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hathaichanok","family":"Impheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukdawan","family":"Sukhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Auemphon","family":"Mordmuang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"893_CR1","doi-asserted-by":"publisher","first-page":"3467381","DOI":"10.1155\/2019\/3467381","volume":"2019","author":"G Bikbova","year":"2019","unstructured":"Bikbova G, Oshitari T, Baba T, Yamamoto S, Mori K. Pathogenesis and management of macular hole: review of current advances. J Ophthalmol. 2019;2019:3467381.","journal-title":"J Ophthalmol"},{"issue":"6","key":"893_CR2","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1007\/s00417-017-3598-9","volume":"255","author":"T Rossi","year":"2017","unstructured":"Rossi T, Gelso A, Costagliola C, Trillo C, Costa A, Gesualdo C, Ripandelli G. Macular hole closure patterns associated with different internal limiting membrane flap techniques. Graefes Arch Clin Exp Ophthalmol. 2017;255(6):1073\u20138.","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"issue":"1","key":"893_CR3","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s40942-023-00509-1","volume":"9","author":"AU Dera","year":"2023","unstructured":"Dera AU, Stoll D, Schoeneberger V, Walckling M, Brockmann C, Fuchsluger TA, Schaub F. Anatomical and functional results after vitrectomy with conventional ILM peeling versus inverted ILM flap technique in large full-thickness macular holes. Int J Retina Vitreous. 2023;9(1):68. https:\/\/doi.org\/10.1186\/s40942-023-00509-1.","journal-title":"Int J Retina Vitreous"},{"issue":"10","key":"893_CR4","doi-asserted-by":"publisher","first-page":"2018","DOI":"10.1016\/j.ophtha.2010.02.011","volume":"117","author":"Z Michalewska","year":"2010","unstructured":"Michalewska Z, Michalewski J, Adelman RA, Nawrocki J. Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology. 2010;117(10):2018\u201325.","journal-title":"Ophthalmology"},{"issue":"Suppl 1","key":"893_CR5","doi-asserted-by":"publisher","first-page":"S95","DOI":"10.1097\/IAE.0000000000002320","volume":"39","author":"S Rizzo","year":"2019","unstructured":"Rizzo S, Caporossi T, Tartaro R, Finocchio L, Franco F, Barca F, et al. A human amniotic membrane plug to promote retinal breaks repair and recurrent macular hole closure. Retina. 2019;39(Suppl 1):S95\u2013103.","journal-title":"Retina"},{"issue":"3","key":"893_CR6","doi-asserted-by":"publisher","first-page":"748","DOI":"10.3390\/pharmaceutics15030748","volume":"15","author":"N Fitriani","year":"2023","unstructured":"Fitriani N, Wilar G, Narsa AC, Mohammed AFA, Wathoni N. Application of amniotic membrane in skin regeneration. Pharmaceutics. 2023;15(3):748.","journal-title":"Pharmaceutics"},{"key":"893_CR7","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1016\/j.actbio.2019.06.002","volume":"94","author":"Y Mao","year":"2019","unstructured":"Mao Y, Hoffman T, Dhall S, Singal A, Sathyamoorthy M, Danilkovitch A, Kohn J. Endogenous viable cells in lyopreserved amnion retain differentiation potential and anti-fibrotic activity in vitro. Acta Biomater. 2019;94:330\u20139.","journal-title":"Acta Biomater"},{"issue":"3","key":"893_CR8","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1016\/j.jfo.2022.07.001","volume":"46","author":"H Zhang","year":"2023","unstructured":"Zhang H, Li Y, Chen G, Han F, Jiang W. Human amniotic membrane graft for refractory macular hole: a single-arm meta-analysis and systematic review. J Fr Ophtalmol. 2023;46(3):276\u201386.","journal-title":"J Fr Ophtalmol"},{"key":"893_CR9","doi-asserted-by":"publisher","first-page":"1358977","DOI":"10.3389\/fbioe.2024.1358977","volume":"12","author":"G Kafili","year":"2024","unstructured":"Kafili G, Niknejad H, Tamjid E, Simchi A. Amnion-derived hydrogels as a versatile platform for regenerative therapy: from lab to market. Front Bioeng Biotechnol. 2024;12:1358977.","journal-title":"Front Bioeng Biotechnol"}],"container-title":["International Journal of Retina and Vitreous"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40942-026-00893-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40942-026-00893-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40942-026-00893-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T22:39:24Z","timestamp":1789079964000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40942-026-00893-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["893"],"URL":"https:\/\/doi.org\/10.1186\/s40942-026-00893-4","relation":{},"ISSN":["2056-9920"],"issn-type":[{"value":"2056-9920","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]},"assertion":[{"value":"20 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was conducted in accordance with the tenets of the Declaration of Helsinki and approved by the Institutional Review Board of Walailak University (IRB No. WUEC-24-331-01). Written informed consent was obtained prior to all study procedures.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent for publication of clinical data and all accompanying images was obtained from the patient. A copy of the signed consent is available to the Editor-in-Chief upon request.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"121"}}