Autologous Retinal Transplantation for Macular Holes
Ophthalmology, May 2021
The advent of autologous retinal trans-plantation (ART) has generated new ways of managing macular holes (MHs). Building on a pilot study showing success of ART for MH closure in the hands of different surgeons, Moysidis et al. investigated real-world outcomes. They found closure rates of 89% for MH and 95% for MHs with rhegmatogenous retinal detachment (MH-RRD). Moreover, the gains in visual acuity (VA) were substantial.
The goal of this multicenter study was to explore anatomic and functional outcomes for patients with MHs treated by ART. A worldwide open invitation for case contributions was announced at scientific meetings, through societies, and by email. Participating surgeons shared details on consecutive cases via a standardized data-collection form.
Altogether, 33 vitreoretinal surgeons contributed a total of 130 cases treated from 2017-2019. The mean maximum MH diameter was 1,470 μm, mean minimum diameter was 840 μm, and mean axial length was 24.6 mm. All patients underwent pars plana vitrectomy and ART, with intraoperative variables modified appropriately by the surgeon. OCT images were graded by two masked reviewers. Main outcomes were MH closure rate, VA, integrity of external limiting membrane and ellipsoid zone band, and alignment of neurosensory layers (ANL).
The mean age of the patients was 63 years. The indication for ART was primary MH in 27%, refractory MH in 58%, and MH-RRD in 15%. Mean VA improved from 1.37 ± 0.12 logMAR preoperatively to 1.05 ± 0.09 postoperatively (mean follow-up, 8.6 months). Closure rates were 89% for MH (78.5% complete; 10% small eccentric defect) and 95% for MH-RRD (68.4% complete; 26.3% small eccentric defect). VA improved by 3 or more lines in 43% of eyes and by 5 or more in 29%. Reconstitution of ANL (p = .01) and the ellipsoid band (p = .02) led to better visual outcomes. Dislocation of the ART graft occurred in five cases (3.8%). There were five cases of post-op retinal detachment (3.8%) and one case of endophthalmitis (0.77%).
The original article can be found here.