Autologous Retinal Transplant in Refractory Macular Holes

Purpose: To report the structural and functional outcomes of autologous neurosensory retinal transplant for closure of refractory macular holes (MHs) and to highlight the long-term follow-up findings. Methods: Nine eyes of 9 patients with full-thickness MH refractory to previous vitrectomy with internal limiting membrane (ILM) peeling and tamponade underwent pars plana vitrectomy, autologous retinal transplant with short-term perfluoro-n-octane heavy liquid, followed by gas tamponade. Patients were followed for 12.7 ± 10 months (range, 3-32 months). Results: Optical coherence tomography showed complete anatomic closure of the MH in 8 of 9 eyes (89%). Restoration of the outer retina and integration of the neurosensory retinal flap were noted in 5 eyes. The mean corrected Snellen visual acuity (VA) was 20/1600 and improved postoperatively to 20/200. The logMAR VA improved postoperatively from 1.9 ± 0.2 (range, 1.3-2) to 1.0 ± 0.3 (range, 0.59-1.3). Three grafts developed epiretinal membranes and were observed. Graft shrinkage over time was noted in 1 patient. One patient with a chronic large MH and previous panretinal photocoagulation (PRP) had a successful transplant from retinal tissue that had undergone PRP. One eye developed retinal detachment with proliferative vitreoretinopathy (PVR) that was managed with scleral buckle, PVR peeling, and silicone oil tamponade. This was followed by a successful repeat autologous retinal transplant from the detached nasal retina and nasal 120 degrees retinectomy. Conclusions: Autologous retinal transplant for large refractory MHs provides anatomic closure and safely improves VA.