OCT-Assisted Macular Hole Closure with Autologous Retinal Patch Graft

In this video, Drs. Kinza Ahmad and Sami Uwaydat show an intraoperative OCT-assisted closure technique utilizing an autologous retinal patch graft for a large traumatic macular hole. The hole was not amenable to closure with an inverted internal limiting membrane (ILM) flap technique. A 23-gauge pars plana vitrectomy setup was used with an Eckardt twin-light chandelier. An area of the retina was demarcated with laser and diathermy, and elevated using a subretinal injection of BSS with a 38-gauge silicone tip cannula. Dissection of retinal tissue was done using a retinal pick and scissors and the patch of retinal tissue was excised. Perfluorocarbon liquid was used to stabilize the retinal patch graft.

Intraoperative OCT was used to confirm the position of the graft over the hole, as well as its orientation, with the ganglion cell layer facing inward. Perfluorocarbon liquid was left in the eye, then removed 2 weeks later. Postoperative OCT performed in the clinic showed successful anatomical closure of the macular hole. However, visual improvement was limited (preoperative and postoperative vision remained at count fingers 2 to 3 ft) probably due to pre-existing traumatic optic neuropathy.

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