Autologous full-thickness retinal transplant for refractory large macular holes

Abstract

Background Despite the constant refinement of techniques and surgical aids, extremely large and refractory macular holes continue to have poor surgical outcomes with the current standard of care. The objective of the present study is to assess the anatomical and functional outcomes, as well as the structural change through time, of the optical coherence tomography of patients with refractory macular holes treated with a full-thickness autologous retinal transplant. Methods Prospective, case series. We include patients with a clinical diagnosis of refractory macular holes with a minimum diameter of at least 500 µm. All the patients had a comprehensive ophthalmological examination, which included a best-corrected visual acuity assessment, fundus examination, and optical coherence analysis. All the patients underwent a 23-gauge pars plana vitrectomy with a full-thickness retinal transplant and silicone oil tamponade (5000 cs<). Follow-up was done at 1, 3, 6, and 12 months. Statistical analysis was done with a test for repeated measurements and Bonferroni correction, with an alpha value of 0.05 for statistical significance and a Mann-Whitney U test for nonparametric continuous variables. Results We enrolled 13 eyes from 13 patients (mean age: 67.15 years) with refractory macular holes, with a mean base diameter of 1615.38 ± 689.19 µm and a minimum diameter of 964.08 ± 709.77 µm. The closure rate after 12 months of follow-up was 76.92%. Six patients with a closed macular hole at the end of the follow-up had complete recovery of the myoid/ellipsoid layer. The remaining showed a 44.9% reduction of the initial gap. Most patients formed a pseudofovea and normalization of the internal retinal layers. Despite a positive trend toward visual recovery (p = 0.034), after the correction of the alpha value, the change lost its statistical significance. During follow-up, one patient developed mild proliferative vitreoretinopathy and epiretinal membrane without anatomical or functional consequences. Conclusions An autologous full-thickness retinal transplant may improve the anatomical and structural outcome of patients with refractory macular holes. The full safety profile of this new technique is still unknown. More studies are needed in order to assess functional changes through time.

Surgical Management of Recurrent and Persistent Macular Holes: A Practical Approach

“…The mean visual acuity improved in 36.6% of eyes, remained stable in 41.5% of eyes, and worsened in 21.9% of eyes. Similar anatomic success rates have been found in additional case series, though results for functional improvement have been less consistent [ 68 – 71 ]. In a recent prospective case series of 13 eyes with refractory MHs (mean minimum diameter 964.38 ± 709.77 µm, mean base diameter 1615.38 ± 689.19 µm), closure rate after 12 months was 76.9% with this technique but there was no statistically significant improvement in vision [ 71 ].…”

Amniotic Membrane Graft for the Treatment of Large Refractory Macular Hole

“…Autologous retinal transplant was shown to be capable of achieving 88% of anatomical MH closure in a multicenter case series of MHs refractory to previous vitrectomy with ILM peeling. 24 Other case series have also reported similar anatomical success rates although functional improvement was less consistent across these studies 12,25,26 In a recent prospective study conducted on 13 eyes with refractory MHs, closure rate after one year was 76.9% with however no significant improvement in visual acuity 12…”

Autologous Neurosensory Retinal Transplantation

“…9 Many patients gained several lines of visual acuity (Table 2). 9,10,25,[28][29][30][31][32][33][34] In the largest ART series, 12% of patients attained a postoperative visual acuity of 20/50 or better after ART for primary or refractory MH; none of these patients underwent ART for combined MH-retinal detachment. 28 Anatomic features associated with significant visual acuity improvement included ellipsoid zone reconstitution and alignment of neurosensory layers (ANLs) (graft inner plexiform layer to host inner plexiform layer, graft outer plexiform layer to host outer plexiform layer, etc.).…”