Abstract
Purpose :
Surgical closure and visual improvement of large macular holes (MH) remain challenging. This study reports outcomes of autologous retinal free flap transplantation surgery for large chronic MH evaluated by best corrected visual acuity (BCVA), optical coherence tomography (OCT), multifocal ERG (mfERG) and microperimetry.
Methods :
3 patients with large chronic MH underwent vitrectomy and free-flap retinal transplantation with silicone oil tamponade. The hole was closed with an autologous retinal transplant of an approximate diameter of 1.5-1.8 mm harvested outside the vascular arcades and placed in the foveal region. Surgeries were performed at the Eye Hospital, UMC Ljubljana. Patients were followed for 17.5±4.43 months for anatomical and functional outcomes using BCVA (Snellen), OCT (Spectralis), microperimetry (MP1, Nidek) and mfERG (Roland Consult).
Results :
The average preoperative size of the MH was 1537.67±741.16 (868 – 2334) µm at the widest and 737.33±184.58 (556-925) µm at the minimum diameter. Surgery resulted in anatomical closure of the MH in all cases. OCT showed structural integration of the transplant and re-appearance of the inner segment ellipsoid (ISe) to different extents. BCVA improved from preoperative 0.1, 0.1 and 0.005 to 0.2 postoperatively in all patients. (Fig.1)
At the follow-up period, microperimetry showed improvement of function in the peripheral areas of the transplants (6.8 dB; range 2.5-12.4 dB). Fixation was relatively unstable, located on or near the border of the transplant either in the nasal or nasal-superior perifoveal region. No function was seen in the center of transplants during the follow up time. (Fig.1) Multifocal ERG showed reduced but preserved function of the central ring and normal function in the 2nd ring in all cases (1st mfERG ring: 45.1, 42.1 and 56.4 nV vs. normal value: 91.6 nV, 2nd mfERG ring: 51.9, 45.1 and 48.0 nV vs. normal value: 40.8 nV). Follow-up recordings in one patient showed improvement of the responses. (Fig.2)
Conclusions :
Autologous retinal transplantation surgery is successful technique for closing large refractory MHs. OCT revealed reappearance of ISe with improvement of visual function in the pericentral regions of the transplant. Retinal function was demonstrated on the peripheral regions of the transplant using microperimetry and mfERG suggesting its functional integration.
This is a 2020 ARVO Annual Meeting abstract.