Autologous neurosensory retinal transplant surgery proved successful in closing refractory macular holes and also improving vision in some cases.
A retrospective case series involved 41 eyes of 41 patients operated on in four centers located in the United States, Italy and Japan between May 2015 and June 2017. Following three-port 20-, 23- or 25-gauge pars plana vitrectomy, a full-thickness neurosensory retinal free flap of approximately 2 disc diameters was harvested from the mid-periphery of the retina. The graft was then placed on the macular hole. PFC heavy liquid was instilled over the flap, which was gently flattened and stretched to cover the hole completely. Intraocular tamponade was applied, and the patient was placed facedown for 1 week.
Complete anatomic closure was obtained in 36 eyes (87.8%), of which 19 (52.3%) gained visual acuity and 12 (33%) maintained baseline visual acuity.
From this initial experience, the authors learned that the size of the retinal flap should be 0.5 disc diameter larger than the size of the macular hole to allow proper handling and maintain stable positioning during fluid-air exchange.
“Further refinement of surgical techniques will help optimize sustained flap positioning,” they wrote.
Integration of the retinal flaps was visible on OCT scans, showing bridging tissue in the junctional area. The mechanism of this integration, the partial outer retinal layer restoration and the improved visual function remains unclear.
“Overall, there was a high degree of anatomic success, and the technique proved safe in this initial experience for closure of refractory [macular holes],” the authors wrote. “Such patients did not previously have viable surgical options available, and this technique may provide the basis of a surgical technique upon which other improvements can be built and serve an important tool in the surgical armamentarium for management of such challenging refractory [macular holes].” – by Michela Cimberle
Disclosure: Grewal reports he is a consultant for Allergan and Alimera. Please see the study for all other authors’ relevant financial disclosures.