Optical Coherence Tomography Angiography in Macular Holes Autologous Retinal Transplant

Area of Science:

• Ophthalmology
• Retinal Surgery
• Vascular Biology

Background:

• Refractory macular holes (MH) pose significant challenges in visual restoration.
• Pars plana vitrectomy with autologous retinal transplant (ART) is a surgical option for these cases.
• Understanding the microvascular changes post-ART is crucial for evaluating treatment efficacy.

Purpose of the Study:

• To compare post-operative macular microvascular parameters in eyes with refractory macular holes (MH) treated with pars plana vitrectomy and autologous retinal transplant (ART).
• To assess changes in vascular density (VD) and foveal avascular zone (FAZ) area after ART.
• To correlate microvascular changes with visual acuity outcomes.

Main Methods:

• Retrospective case control study of six patients undergoing pars plana vitrectomy and ART for refractory MH.
• Pre-operative Spectral Domain Optical Coherence Tomography (SD-OCT) and post-operative Optical Coherence Tomography Angiography (OCT-A).
• Analysis of vascular density (VD) and foveal avascular zone (FAZ) area, compared with fellow unoperated eyes.

Main Results:

• All six eyes achieved MH closure with a mean follow-up of 24 months.
• Post-operative visual acuity did not significantly improve compared to pre-operative best-corrected visual acuity (BCVA).
• Eyes with closed MH exhibited significantly larger FAZ areas (109.8 ± 114.6 mm²) and higher VD (28.1 ± 7.3%) than control eyes (FAZ: 41.5 ± 10.4 mm², VD: 20.2 ± 2.9%).

Conclusions:

• Pars plana vitrectomy and ART can achieve anatomical closure of refractory macular holes.
• Despite successful MH closure, ART did not lead to significant visual acuity improvement in this cohort.
• Macular microvasculature shows distinct changes post-ART, with larger FAZ and increased VD compared to healthy eyes.