Autologous Retinal Transplant for Refractory Macular Holes: Multicenter International Collaborative Study Group
Grewal DS, Charles S, Parolini B, Kadonosono K, Mahmoud TH. Autologous Retinal Transplant for Refractory Macular Holes: Multicenter International Collaborative Study Group. Ophthalmology 2019 Oct;126(10):1399-1408
Single surgery success rates are high for primary macular holes and are often reported to be higher than 90%. Modern techniques typically involve pars plana vitrectomy, internal limiting membrane peel and gas tamponade with or without face-down positioning. Several factors, including large size, chronicity, and high myopia, can lower the primary surgical success rate. Anatomic closure may be even more difficult in refractory macular holes after prior surgeries with wide removal of ILM. Autologous retinal free flap is a technique first described for closure of myopic macular holes associated with foveoschisis. The present study is a multicenter, retrospective, consecutive case series of 41 eyes with a macular hole refractory to prior vitrectomy that underwent autologous retinal transplant.
Of these 41 eyes, anatomic closure was achieved in 36/41 eyes (87.8%) with an improvement in mean corrected visual acuity from 1.11 ± 0.66 to 1.03 ± 0.51 (logMAR) at the last postoperative visit. The mean follow-up period was 11.1 ± 7.7 months. The anatomic closure rate for this series is impressive given the large preoperative hole size (1468.1 ± 656.4 µm) and the number of prior surgeries (mean 1.5 ± 0.94). The authors reported confidence in this technique to potentially become even the primary procedure in cases with difficult pathology such as large and myopic macular holes.
The main take home point from this study is that high anatomic closure rates can be achieved with autologous retinal transplant for refractive cases and it offers a chance to stabilize or even improve vision in some cases. Left untreated visual acuity may continue to deteriorate in eyes with refractory macular holes and there is a risk of retinal detachment in myopic eyes. Although the mechanism remains unclear, there appears to be some structural integration of the retinal layers between the autologous retinal flap and the surrounding host tissue as well as improved visual function in some cases.