Abstract
Purpose :
Various surgical techniques have been described for managing persistent macula holes following unsuccessful vitrectomy with ILM peeling. However the closure rate and functional improvement after these procedures are limited. This study investigates the clinical outcome of subretinal autologous internal limiting membrane (ILM) transplantation during pars-plana vitrectomy for persistent full-thickness macular hole (FTMH) repair.
Methods :
Retrospective, consecutive case series of 13 eyes (13 patients) undergoing small-incision re-vitrectomy with ILM transplantation and air tamponade for large persistent FTMH after prior unsuccessful vitrectomy with posterior hyaloid detachment and ILM peeling. In all eyes, high-definition SD-OCT scans (SD-OCT Spectralis, Heidelberg Engineering GmbH, Germany) of the macula were routinely performed before surgery, 1 and 4 weeks after surgery, and at the final follow-up visit. Furthermore, age, gender, axial length, macular hole diameter, biomicroscopic fundus evaluation and best-corrected visual acuity (BCVA) in logMAR and Snellen at baseline, 1 and 4 weeks after surgery, and at the final follow-up visit were analyzed.
Results :
Anatomic closure was achieved in all 13 FTMH (100%) after 3 days. Closure patterns were classified according to Rossi et al (2020). Mean baseline BCVA logMAR was 0.93, mean postoperative BCVA logMAR was 0.66 with a mean postoperative follow-up period of 11.4 months. BCVA improved significantly in 9 eyes (69%), remained stable in 2 eyes (15%) and deteriorated in 2 eyes ude to retinal pigment epithelial atrophy. No re-opening occurred during the observation period.
Conclusions :
The results of this case series suggest that autologous ILM-transplant into the subretinal space under the margin of the FTMH in persistent macula holes supports anatomic closure and functional improvement in large persistent FTMHs.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.