Purpose To report the surgical outcome and postoperative hypopigmented change around fovea among patients with high myopia who received human amniotic membrane (hAM) graft transplantation for macular hole (MH).

Method This retrospective, interventional case series included 10 eyes of 10 consecutive patients (5 (50%) male) with high myopia (axial length over 26.5 mm) who received hAM graft to treat persisted or chronic MH with or without retinal detachment in two hospitals. Postoperative parafoveal atrophy was identified with colour fundus picture and structure optical coherent tomography. Baseline characteristics and short-term visual outcome were analysed.

Results The preoperative mean (±SD) axial length and MH diameter were 29.9 (±1.8) mm and 881.8 (±438.5) μm, respectively. After hAM transplantation, seven (70%) eyes had complete MH closure and the mean best-corrected visual acuity (BCVA) improved from 1.26 (±0.48) logarithm of minimal angle of resolution (logMAR) before operation to 1.11 (±0.44) logMAR on the last visit (p=0.074). Patchy atrophy-like depigmentation developed around the MH lesion in four (40.0%) eyes as early as in the first month after surgery. None of them had visual worsening. In terms of demographics, axial length, MH size, ocular history, preoperative BCVA and postoperative BCVA, there was no significant difference between those with and without the parafoveal atrophy. No graft rejection and inflammation happened during the follow-up.

Conclusion Parafovea atrophy, a rare complication in the conventional MH surgery, was observed in 40% of eyes with highly myopic MH after hAM graft transplantation. The pathogenesis and long-term consequence need further investigations.