Patients who have undergone multiple failed procedures to close macular holes may benefit from a new autologous retinal transplantation technique, according to its developer.
Autologous retinal transplantation should be considered for patients who have several failed prior procedures for macular hole or when the internal limiting membrane (ILM) has already been peeled and a free or inverted ILM flap is not an option, Tamer Mahmoud, MD, PhD, developer of the procedure, told Ocular Surgery News.
“The standard procedure is done for patients who present with new holes and have not had prior procedures, and in many of those, the success rate is above 90%. ILM flaps, inverted or free, are to be considered for highly myopic patients or patients who had failed prior ILM peel. The autologous retinal transplant should be considered for failed prior procedures where ILM cannot be harvested to cover the hole,” Mahmoud said.
In the technique, Mahmoud said he first measures the macular hole and then marks an area of the intact superior peripheral retina. A laser is used around the area to prevent future detachment, basically treating it as if it were a retinal break.
Next, diathermy is completed at any of the blood vessels crossing the area, he said.
“A chandelier is inserted for bimanual techniques. Forceps and scissors are used to cut the retinal transplant from the donor area. The transplant is moved to cover the hole. One hand still has the forceps to keep the transplant in place, and a dual bore cannula is used with perfluorocarbon (PFC) in the second hand to inject PFC and stretch the transplant over the hole and then use the tip to adjust it in place. Fill the eye with PFC, and then direct PFC silicone oil exchange is done to keep the transplant in place,” he said.
Mahmoud described the case of a 15 D myopic woman who had previously undergone a pars plana vitrectomy with ILM peeling 6 months earlier, complicated by a refractory macular hole and retinal detachment.
Following an autologous retinal flap transplant, Mahmoud said the macular hole closed and visual acuity improved from 1 logMAR to 0.6 logMAR, with reduction in the scotoma size and improvement in microperimetry.
There is a great future for the technique, according to Mahmoud, who suggested that autologous retinal transplant could even be considered when ILM is still obtainable.
Autologous retinal transplantation may have additional applications as ophthalmologists continue to understand the role of the peripheral retina in potentially acquiring macular morphology and function, Mahmoud said.
“I have also transplanted retina and choroid in cases of macular hole with macular degeneration and feel there is huge potential in such pathology,” he said. – by Robert Linnehan
- Grewal DS, et al. JAMA Ophthalmol. 2016;doi:10.1001/jamaophthalmol.2015.5237.
- Grewal DS, et al. Ophthalmic Surg Lasers Imaging Retina. 2016;doi:10.3928/23258160-20160601-01.
- For more information:
- Tamer Mahmoud, MD, PhD, can be reached at Duke Eye Center, 2351 Erwin Road, Durham, NC 27710; email: firstname.lastname@example.org.
Disclosure: Mahmoud reports he is a consultant for Dutch Ophthalmic Research Center and Alimera Sciences and completes research for Genentech and Alcon.