Internal limiting membrane transplantation for unclosed and large macular holes

To present the surgical technique and clinical outcomes of transplantation of autologous internal limiting membrane (ILM) for large macular holes (MHs) after failed surgeries with ILM removal.

Thirteen eyes of 13 consecutive patients with MHs larger than 500 μm after failed surgeries with ILM removal underwent vitrectomy with transplantation of autologous ILM. In the ILM transplantation technique, a small piece of the ILM was peeled off and transplanted inside the macular hole. Fluid-air exchange was then performed. The air was then replaced with 10 % perfluoropropane (C₃F₈) gas. Comprehensive ophthalmologic examinations and spectral-domain optical coherence tomography were performed preoperatively and postoperatively. The main outcome measures were best-corrected Snellen visual acuity (BCVA) and MH closure rate.

The preoperative mean base diameter of the MHs was 1637.6 + 412.7 μm (range, 814-2092 μm). The preoperative mean minimum diameter was 814.4 + 255.0 μm (range, 546 μm-1485 μm). Complete MH sealing was achieved in 12 eyes after transplantation of the ILM flap. The mean BCVA was 1.15 + 0.21 (range, 1.0-1.6) before surgery and 0.99 + 0.17 (range, 0.7-1.3) at 12 months postoperatively. There was a significant difference in BCVA before versus after the surgery (t = 3.825, P = 0.0002, paired t- test).

Transplantation of autologous ILM is an effective addition to the surgical options for large macular holes after failed surgeries with ILM removal.