Autologous retinal transplant successfully closes refractory macular holes
medwireNews: Autologous neurosensory retinal transplantation results in the closure of full thickness macular holes in the vast majority of patients for whom previous surgery has failed, study findings indicate.
The technique also resulted in restoration of the ellipsoid zone (EZ) and external limiting membrane (ELM) overall, as well as improved visual acuity (VA) in more than a third of the 41 patients (mean age 61 years, 66% women) included in the multicentre retrospective study.
All of the patients had previously undergone an internal limiting membrane (ILM) peel in the affected eye, with the number of prior surgeries ranging from one to three (mean=1.5).
“Such patients did not previously have viable surgical options available and this technique may provide the basis of a surgical technique upon which other improvements can be built and serve an important tool in the surgical armamentarium for management of such challenging refractory macular holes”, say Tamer Mahmoud (Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA) and co-investigators.
The surgery comprised pars-plana vitrectomy, followed by autologous neurosensory retinal transplant with either gas, silicone oil tamponade or short-term perfluoro-n-octane heavy-liquid tamponade.
After an average 11.1 months of follow-up, 87.8% of patients had complete anatomical closure of the macular hole when assessed by optical coherence tomography.
Furthermore, the proportion of closures was 89.3% among the 28 patients who had high myopia at baseline and was 100% among four patients with an associated myopic hole retinal detachment, “demonstrating that this technique offers a high anatomical closure rate in these challenging cases where ILM based techniques are not an option”, the researchers remark.
The mean logarithm of the minimum angle of resolution (logMAR) VA (converted from Snellen VA) improved significantly from 1.11 before surgery to 1.03 at the last postoperative visit.
Overall, 36.6% of eyes had an improvement of at least 0.3 logMAR, while 21.9% experienced a decline of at least 0.3 logMAR units. The corresponding proportions among the eyes with anatomical closure were 52.3% and 13.8%, whereas in those without closure, no eyes had improved VA and 20.0% had a decline.
The team also found that the mean EZ defect decreased significantly from 1777.3 μm preoperatively to 1370.0 μm at final follow-up, while the ELM reduced from 1681.5 μm to 1408.5 μm.
Following surgery, there were no cases of proliferative vitreoretinopathy, endophthalmitis, suprachoroidal haemorrhage or choroidal neovascularisation at either the graft site or the harvest site, and there was one case each of retinal detachment vitreous haemorrhage.
Writing in Ophthalmology, Mahmoud and colleagues argue “that an un-operated macular hole, whether primary or recalcitrant to previous surgery, is a potential lost opportunity to stabilize or improve vision.”
“To minimize or avoid decline of macular function, there may be benefit to surgery, even if visual acuity is not expected to improve much, or at all”, they add.
The researchers caution, however, that they would not “recommend this procedure in eyes with extensive chorioretinal scarring that would preclude obtaining a viable retinal transplant or those with retinal ischemia, neovascularization and inflammation.”
By Laura Cowen
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