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Peiquan Zhao, Haiying Jin, Jie Peng, Hongtao Zhang; Allogenic anterior capsular flap transplantation in the management of refractory macular holes. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5928.
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To present a new surgical technique of allogenic anterior capsular flap transplantation in the management of refractory macular hole(MH) and to evaluate the safety and reliability of the technique.
Allogenic capsular flap was obtained from healthy age-related cataractous donators. Before cataract surgery, serological screenings of the infectious diseases were performed. Anterior capsular flap was immersed in distilled water for five minutes. The flap was then rinsed by BSS for three times and preserved in BSS. Surgical procedures of capsular flap transplantation were performed using standard 23-gauge pars plana vitrectomy system. The capsular flap was trimmed by vitreous cutter to a size which is a little larger than that of the MH and was placed into the hole with microforceps. Autologous transplantations using the anterior capsular flap from the fellow eyes performed in the same procedure were served as the control group.
A total of 21 eyes of 21 patients were transplanted with the allogenic anterior capsular flaps. The average age was 60.40 ± 18.74 years (range, 25–79 years). The average size of the MH before the surgery was 788.80 ± 230.11 μm (range, 685 to 1564 μm). The duration from the previous surgeries varied greatly ranging from 3 months to 96 months (mean, 24.35 ±14.67 months). The initial conditions associated with the MH formation were high myopia with MH and retinal detachment, MH after myopic foveoschisis surgery, high myopia with a large MH, chronic MH and traumatic MH. The MHs of all the 21 eyes were closed postoperatively. The averaged best corrected visual acuity(BCVA) in logMAR before and after the transplantation was 1.55± 0.45 and 1.18 ± 0.40, respectively (P = 0.04, paired t-test). The postoperative BCVA gained 0.2 logMAR units or more in 16 eyes and remained unchanged in 5 eyes. No eyes had deteriorated BCVA. Intraoperative or postoperative vision threatening complications did not occur in all the cases.
Transplanting allogenic lens capsule generated higher closure rate and significant benefits as the autogenous group in terms of macular morphology and visual acuity. A longer follow-up with more cases is desirable to evaluate the long-term effects of the present technique.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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