Autologous neurosensory retinal transplantation for the treatment of refractory large macular hole_Chinese Journal of Ocular Fundus Diseases

Authors：

Deng Xianming ,  Wang Wenzhan , Ma Chao , Shi Jing

Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Henan Provincial Ophthalmic Hospital, Zhengzhou 450052, China;

Corresponding author：

Wang Wenzhan, Email: 18003857188@189.cn

Keywords：

Large macular hole; Refractory macular hole; Autologous neurosensory retinal transplantation; Pars plana vitrectomy

DOI：

10.3760/cma.j.cn511434-20231229-00502

Video：

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Objective To observe the therapeutic effect of autologous neurosensory retinal transplantation in repairing unhealed giant macular hole after pars plana vitrectomy (PPV). Methods A prospective clinical study. From July 2022 to December 2023, 12 patients (12 eyes) with refractory large macular hole who received autologous neurosensory retinal transplantation treatment in Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University were selected for the study. The macular hole in affected eyes still did not close after PPV combined with inner limiting membrane removal or tamponade, and the diameter of macular hole were greater than 600 μm. All affected eyes received best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. The BCVA examination employed the international standard visual acuity chart, with results converted to logarithm of the minimum angle of resolution (logMAR) visual acuity for statistical analysis. During the surgery, a piece of healthy retinal neuroepithelial tissue, approximately 0.3 optic disc diameters larger than the macular hole, was removed from the upper retinal periphery and used as a graft. The graft was inserted into the macular hole with the aid of intraoperative OCT. Post-surgery, the vitreous cavity was filled with silicone oil or sterile air. The follow-up period after surgery was 6 months. The thickness of the retinal grafts was measured using the same equipment as before surgery at 3 days, 1, 3, and 6 months post-surgery. The primary focus was on observing the macular hole closure rate and changes in BCVA at 6 months post-operation. A paired t-test was used to compare BCVA before and after surgery. Results In the sample of 12 cases (12 eyes), there were 5 males with 5 eyes and 7 females with 7 eyes. The mean age was (50.4±12.6) years. The mean macular hole diameter was (1 085.6±344.0) μm; The mean eye axis length was (27.64±4.19) mm. At 6 months after surgery, all affected eyes showed macular hole were completely closed (100.0%, 12/12). The thickness of the retinal graft was measured as (206.8±21.0), (170.8±23.3), (165.6±31.6), and (157.9±31.1) μm at 3 days, 1, 3, and 6 months post-surgery, respectively. At before and 6 months after surgery, the logMAR BCVA of the affected eyes was 1.28±0.39 and 0.95±0.22, respectively. The difference in logMAR BCVA before and after surgery was statistically significant (t=3.40, P＜0.05). Conclusion Autologous neurosensory retinal transplantation could effectively improve the closure rate of refractory large macular hole and improve or stabilize vision in the short run.

Citation： Deng Xianming, Wang Wenzhan, Ma Chao, Shi Jing. Autologous neurosensory retinal transplantation for the treatment of refractory large macular hole. Chinese Journal of Ocular Fundus Diseases, 2024, 40(8): 619-623. doi: 10.3760/cma.j.cn511434-20231229-00502 Copy

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8.	Grewal DS, Mahmoud TH. Autologous neurosensory retinal free flap for closure of refractory myopic macular holes[J]. JAMA Ophthalmol, 2016, 134(2): 229-230. DOI: 10.1001/jamaophthalmol.2015.5237.
9.	Grewal DS, Fine HF, Mahmoud TH. Management of challenging macular holes: current concepts and new surgical techniques[J]. Ophthalmic Surg Lasers Imaging Retina, 2016, 47(6): 508-513. DOI: 10.3928/23258160-20160601-01.
10.	Kang SW, Ahn K, Ham DI. Types of macular hole closure and their clinical implications[J]. Br J Ophthalmol, 2003, 87(8): 1015-1019. DOI: 10.1136/bjo.87.8.1015.
11.	Chen SN, Yang CM. Inverted internal limiting membrane insertion for macular hole-associated retinal detachment in high myopia[J]. Am J Ophthalmol, 2016, 162: 99-106. DOI: 10.1016/j.ajo.2015.11.013.
12.	Chen SN, Yang CM. Lens capsular flap transplantation in the management of refractory macular hole from multiple etiologies[J]. Retina, 2016, 36(1): 163-170. DOI: 10.1097/IAE.00000000 00000674.
13.	Baba R, Wakabayashi Y, Umazume K, et al. Efficacy of the inverted internal limiting membrane flap technique with vitrectomy for retinal detachment associated with myopic macular holes[J]. Retina, 2017, 37(3): 466-471. DOI: 10.1097/IAE.0000000000001211.
14.	Lai CC, Chen YP, Wang NK, et al. Vitrectomy with internal limiting membrane repositioning and autologous blood for macular hole retinal detachment in highly myopic eyes[J]. Ophthalmol, 2015, 122(9): 1889-1898. DOI: 10.1016/j.ophtha.2015.05.040.
15.	Grewal DS, Charles S, Parolini B, et al. Autologous retinal transplant for refractory macular holes: multicenter international collaborative study group[J]. Ophthalmol, 2019, 126(10): 1399-1408. DOI: 10.1016/j.ophtha.2019.01.027.
16.	Wu AL, Chuang LH, Wang NK, et al. Refractory macular hole repaired by autologous retinal graft and blood clot[J]. BMC Ophthalmol, 2018, 18(1): 213. DOI: 10.1186/s12886-018-0898-8.
17.	Li Y, Li Z, Xu C, et al. Autologous neurosensory retinal transplantation for recurrent macular hole retinal detachment in highly myopic eyes[J]. Acta Ophthalmol, 2020, 98(8): 983-990. DOI: 10.1111/aos.14442.
18.	Ruiz-Moreno JM, Arias L, Araiz J, et al. Spectral-domain optical coherence tomography study of macular structure as prognostic and determining factor for macular hole surgery outcome[J]. Retina, 2013, 33(6): 1117-1122. DOI: 10.1097/IAE.0b013e318285 cc3b. DOI: 10.1097/IAE.0b013e318285cc3b.
19.	Bottoni F, Zanzottera E, Carini E, et al. Re-accumulation of macular pigment after successful macular hole surgery[J]. Br J Ophthalmol, 2016, 100(5): 693-698. DOI: 10.1136/bjophthalmol-2015-307153.
20.	Shiode Y, Morizane Y, Matoba R, et al. The role of inverted internal limiting membrane flap in macular hole closure[J]. Invest Ophthalmol Vis Sci, 2017, 58(11): 4847-4855. DOI: 10.1167/iovs.17-21756.
21.	Ding C, Li S, Zeng J. Autologous neurosensory retinal transplantation for unclosed and large macular holes[J]. Ophthalmic Res, 2019, 61(2): 88-93. DOI: 10.1159/000487952.

1. Foveau P, Conart JB, Hubert I, et al. Anatomical and functional results of macular hole surgery with internal limiting membrane peeling after 10-year follow-up[J]. JFR Ophtalmol, 2016, 39(7): 636-640. DOI: 10.1016/j.jfo.2016.01.011.
2. Matsumura T, Takamura Y, Tomomatsu T, et al. Comparison of the inverted internal limiting membrane flap technique and the internal limiting membrane peeling for macular hole with retinal detachment[J/OL]. PLoS One, 2016, 11(10): e0165068[2016-10-20]. https://pubmed.ncbi.nlm.nih.gov/27764184/. DOI: 10.1371/journal.pone.0165068.
3. Morescalchi F, Costagliola C, Gambicorti E, et al. Controversies over the role of internal limiting membrane peeling during vitrectomy in macular hole surgery[J]. Surv Ophthalmol, 2017, 62(1): 58-69. DOI: 10.1016/j.survophthal.2016.07.003.
4. Kannan NB, Kohli P, Parida H, et al. Comparative study of inverted internal limiting membrane (ILM) flap and ILM peeling technique in large macular holes: a randomized-control trial[J]. BMC Ophthalmol, 2018, 18(1): 177. DOI: 10.1186/s12886-018-0826-y.
5. Gupta B, Laidlaw DA, Williamson TH, et al. Predicting visual success in macular hole surgery[J]. Br J Ophthalmol, 2009, 93(11): 1488-1491. DOI: 10.1136/bjo.2008.153189.
6. Ch’ng SW, Patton N, Ahmed M, et al. The manchester large macular hole study: is it time to reclassify large macular holes?[J]. Am J Ophthalmol, 2018, 195: 36-42. DOI: 10.1016/j.ajo.2018.07.027.
7. D’Souza MJ, Chaudhary V, Devenyi R, et al. Re-operation of idiopathic fullthickness macular holes after initial surgery with internal limiting membrane peel[J]. Br J Ophthalmol, 2011, 95(11): 1564-1567. DOI: 10.1136/bjo.2010.195826.
8. Grewal DS, Mahmoud TH. Autologous neurosensory retinal free flap for closure of refractory myopic macular holes[J]. JAMA Ophthalmol, 2016, 134(2): 229-230. DOI: 10.1001/jamaophthalmol.2015.5237.
9. Grewal DS, Fine HF, Mahmoud TH. Management of challenging macular holes: current concepts and new surgical techniques[J]. Ophthalmic Surg Lasers Imaging Retina, 2016, 47(6): 508-513. DOI: 10.3928/23258160-20160601-01.
10. Kang SW, Ahn K, Ham DI. Types of macular hole closure and their clinical implications[J]. Br J Ophthalmol, 2003, 87(8): 1015-1019. DOI: 10.1136/bjo.87.8.1015.
11. Chen SN, Yang CM. Inverted internal limiting membrane insertion for macular hole-associated retinal detachment in high myopia[J]. Am J Ophthalmol, 2016, 162: 99-106. DOI: 10.1016/j.ajo.2015.11.013.
12. Chen SN, Yang CM. Lens capsular flap transplantation in the management of refractory macular hole from multiple etiologies[J]. Retina, 2016, 36(1): 163-170. DOI: 10.1097/IAE.00000000 00000674.
13. Baba R, Wakabayashi Y, Umazume K, et al. Efficacy of the inverted internal limiting membrane flap technique with vitrectomy for retinal detachment associated with myopic macular holes[J]. Retina, 2017, 37(3): 466-471. DOI: 10.1097/IAE.0000000000001211.
14. Lai CC, Chen YP, Wang NK, et al. Vitrectomy with internal limiting membrane repositioning and autologous blood for macular hole retinal detachment in highly myopic eyes[J]. Ophthalmol, 2015, 122(9): 1889-1898. DOI: 10.1016/j.ophtha.2015.05.040.
15. Grewal DS, Charles S, Parolini B, et al. Autologous retinal transplant for refractory macular holes: multicenter international collaborative study group[J]. Ophthalmol, 2019, 126(10): 1399-1408. DOI: 10.1016/j.ophtha.2019.01.027.
16. Wu AL, Chuang LH, Wang NK, et al. Refractory macular hole repaired by autologous retinal graft and blood clot[J]. BMC Ophthalmol, 2018, 18(1): 213. DOI: 10.1186/s12886-018-0898-8.
17. Li Y, Li Z, Xu C, et al. Autologous neurosensory retinal transplantation for recurrent macular hole retinal detachment in highly myopic eyes[J]. Acta Ophthalmol, 2020, 98(8): 983-990. DOI: 10.1111/aos.14442.
18. Ruiz-Moreno JM, Arias L, Araiz J, et al. Spectral-domain optical coherence tomography study of macular structure as prognostic and determining factor for macular hole surgery outcome[J]. Retina, 2013, 33(6): 1117-1122. DOI: 10.1097/IAE.0b013e318285 cc3b. DOI: 10.1097/IAE.0b013e318285cc3b.
19. Bottoni F, Zanzottera E, Carini E, et al. Re-accumulation of macular pigment after successful macular hole surgery[J]. Br J Ophthalmol, 2016, 100(5): 693-698. DOI: 10.1136/bjophthalmol-2015-307153.
20. Shiode Y, Morizane Y, Matoba R, et al. The role of inverted internal limiting membrane flap in macular hole closure[J]. Invest Ophthalmol Vis Sci, 2017, 58(11): 4847-4855. DOI: 10.1167/iovs.17-21756.
21. Ding C, Li S, Zeng J. Autologous neurosensory retinal transplantation for unclosed and large macular holes[J]. Ophthalmic Res, 2019, 61(2): 88-93. DOI: 10.1159/000487952.

Chinese Journal of Ocular Fundus Diseases

Autologous neurosensory retinal transplantation for the treatment of refractory large macular hole

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