Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia.
Clinic for Eye Diseases, Clinical Centre of Serbia, Pasterova 2, Belgrade, 11000, Serbia.
Graefes Arch Clin Exp Ophthalmol. 2021 Jun;259(6):1443-1453. doi: 10.1007/s00417-020-04981-5. Epub 2020 Oct 22.
To report the safety, anatomical and functional outcomes of autologous neurosensory retinal transplant in patients with a refractory large unclosed macular hole.
This is a prospective case series of four patients with large chronic macular hole that underwent vitrectomy and free-flap neurosensory retinal transplantation surgery with silicone oil tamponade. The hole was closed with an autologous retinal transplant of an approximate diameter of 1.5-1.8 mm, harvested outside the vascular arcades. Anatomical and functional outcomes were assessed using best-corrected visual acuity (BCVA-Snellen), optical coherence tomography (OCT), OCT angiography, microperimetry (MP), and multifocal electroretinography (mfERG).
There were 2 male and 2 female patients with median age of 73 (60-81) years. The median follow-up period was 17 (13-23) months. The median preoperative size of the macular hole was 1872.5 (868-2591) μm at the widest basal diameter and 828 (556-1099) μm at the minimum diameter. Surgery resulted in the anatomical closure of the macular hole in all cases. The OCT showed structural integration of the transplant and reappearance of the inner segment ellipsoid to different extents. The BCVA improved from preoperative 0.1 (6/60; + 1.0 logMAR), 0.1 (6/60; + 1.0 logMAR), 0.05 (6/120; + 1.3 logMAR), and 0.005 (6/1200; + 2.3 logMAR) to 0.2 (6/30; + 0.7 logMAR) postoperatively in cases 1, 2, and 4, and to 0.1 (6/60; + 1.0 logMAR) in case 3. MP showed retinal function in the region corresponding to the area of the transplant (circle of 1.8 mm in diameter) in all patients after the surgery (median sensitivity in that region was 4.0 dB, range 1.8-12.4 dB). Improvement was noted in the patient that had MP performed before the surgery (mean sensitivity improved from 0 to 1.8 dB). Detectable function was mostly located in the peripheral regions of the transplant. Multifocal ERG showed abnormal function of the central ring and normal function of the second ring in 3 of 4 cases. The OCT angiography showed normal perfusion, without signs of neovascularization. There were no intra- or postoperative complications.
Autologous retinal transplantation surgery is a successful technique for closing of large refractory macular holes. The procedure is safe and provides good anatomical results. Visual acuity, microperimetry, and mfERG suggest some gradual functional integration of outer regions of the transplants, but no central functional restitution has been detected as yet.
报告自体感觉神经视网膜移植治疗难治性大未闭黄斑孔的安全性、解剖和功能结果。
这是一项前瞻性病例系列研究，纳入了 4 名患有大慢性黄斑孔的患者，这些患者接受了玻璃体切除术和游离瓣感觉神经视网膜移植手术，并进行了硅油填塞。通过在血管弓外采集直径约为 1.5-1.8 毫米的自体视网膜移植物，将孔封闭。使用最佳矫正视力（BCVA-Snellen）、光学相干断层扫描（OCT）、OCT 血管造影、微视野（MP）和多焦视网膜电图（mfERG）评估解剖和功能结果。
患者中有 2 名男性和 2 名女性，中位年龄为 73（60-81）岁。中位随访时间为 17（13-23）个月。黄斑孔的术前最大直径为 1872.5（868-2591）μm，最小直径为 828（556-1099）μm。所有病例均成功实现黄斑孔的解剖闭合。OCT 显示移植物的结构整合，并在不同程度上重现内层椭圆体。BCVA 从术前的 0.1（6/60；+1.0 logMAR）、0.1（6/60；+1.0 logMAR）、0.05（6/120；+1.3 logMAR）和 0.005（6/1200；+2.3 logMAR）提高至术后的 0.2（6/30；+0.7 logMAR），在病例 3 中提高至 0.1（6/60；+1.0 logMAR）。MP 显示所有患者在手术后（直径 1.8 毫米的圆）在移植区域有视网膜功能（中位敏感度为 4.0dB，范围 1.8-12.4dB）。在术前进行 MP 的患者中，检测到改善（平均敏感度从 0 提高至 1.8dB）。可检测到的功能主要位于移植物的外周区域。多焦视网膜电图显示 4 例中有 3 例中央环功能异常，第二环功能正常。OCT 血管造影显示正常灌注，无新生血管形成迹象。无术中或术后并发症。
自体视网膜移植术是治疗难治性大黄斑孔的成功技术。该手术安全，解剖效果良好。视力、微视野和 mfERG 提示移植区外区域的功能逐渐整合，但尚未检测到中央功能恢复。
