Anatomical and Functional Outcomes of Allogeneic Internal Limiting Membrane Transplantation for Refractory...

To evaluate the anatomical, functional, and outer retinal structural outcomes of allogeneic internal limiting membrane (ILM) transplantation for the treatment of refractory full-thickness macular holes (MH) in eyes where autologous ILM is unavailable due to prior surgery.

This retrospective case series included 13 eyes of 13 patients. All surgeries were performed using a standard pars plana vitrectomy (PPV) under retrobulbar anesthesia. Allogeneic ILM grafts harvested from donor eyes were stored in Eusol-C at 4-8°C and transplanted under perfluorocarbon liquid using a bimanual forceps-assisted technique. When required, additional ILM tissue was inserted for complete defect filling, and the graft was stabilized with a dispersive viscoelastic agent under air. No postoperative head positioning was prescribed. Pre- and postoperative MH size, best-corrected visual acuity (BCVA), closure rate, and closure morphology were analyzed.

Anatomical closure was achieved in all eyes (100%), with primary closure in 12 eyes (92.3%) and successful closure after reoperation in one eye (7.7%). W-type closure was most frequent (61.5%), followed by V-type (30.8%) and U-type (7.7%). BCVA improved significantly from 20/200 (logMAR 1.00) to 20/66 (logMAR 0.52) at final follow-up, corresponding to a median gain of approximately 5 ETDRS lines (p<0.001), whereas intraocular pressure showed no significant change (p=0.118). Despite complete anatomical closure, ellipsoid zone defects persisted in all eyes (100%), and external limiting membrane defects were present in 76.9%, indicating limited outer retinal restoration.

In this 13-case retrospective series, allogeneic ILM transplantation provided consistent anatomical closure and meaningful visual improvement in refractory macular holes lacking autologous ILM, although restoration of outer retinal microstructure remained limited.