MAR 04, 2019
Investigators retrospectively report the structural and functional outcomes of autologous neurosensory retinal transplant for refractory large macular holes.
This multicenter case series comprised 41 patients (41 eyes) with a full thickness macular hole refractory to prior vitrectomy with internal limiting membrane peel and tamponade. Each patient underwent a pars plana vitrectomy and autologous neurosensory retinal transplant with various tamponades. Macular hole closure, visual acuity, OCT findings and surgical complications were analyzed.
During the mean follow-up of 11 months, 36 eyes (87.8%) of eyes had anatomic closure of the macular hole after surgery. The mean corrected visual acuity improved from 1.1 logMAR at baseline to 1.03 logMAR at the last postoperative visit (P=0.03). Significant improvements were noted for ellipsoid zone defect (1777 vs. 1370 μm; P=0.007) and external limiting defect (1682 vs. 1409 μm; P=0.017).
Major postoperative complications included 1 case each of retinal detachment and vitreous hemorrhage. There were no cases of proliferative vitreoretinopathy, endophthalmitis, suprachoroidal hemorrhage, choroidal neovascularization at either the graft site or the harvest site. One eye developed an epiretinal membrane over the harvest site, but this did not impact visual acuity. Cystoid macular edema-like inner retinal cystic changes were seen on OCT in 7 eyes.
This is a retrospective study of this specific technique, so we are unable to make conclusions about outcomes with this technique compared to other techniques currently used for refractory macular holes. Such a comparison is beyond the scope of the current study.
Researchers found a high anatomic closure rate along with improvements in visual acuity and the outer retina using this surgical technique. The study cohort had refractory macular hole, mainly due to hole size. Overall, the technique appears reasonably safe. Autologous retinal transplant is an effective option for macular holes refractory to prior vitrectomy and ILM peeling with tamponade.