Fig. 1.

Combined hAM and MHH technique for repair of large macular holes. The MHH separates the adhesions of the macular hole to the underlying RPE with a soft-tipped cannula through proportional reflux (A) followed by gentle passive aspiration (B). The hAM graft is prepared using a 1-2 mm punch, and a small dot from a marking pen is used to identify the nonsticky epithelial side to ensure that the stromal layer (sticky and nonshiny) is facing downward toward the RPE (C). The graft is then tucked into the space created with MHH between the macular hole edges and the RPE with closed forceps to decrease the likelihood of the graft from dislocating postoperatively (D). Important consideration when preparing the graft is to trim the graft to the size of the macular hole to avoid grafts that are too small or too large (E).