The Anatomical and Functional Outcome of Autologous Internal Limiting Membrane Transplant With 27-Gauge Vitrectomy in Failed and Recurrent Macular Holes in a Spectrum of Pathologies.

OBJECTIVE

To describe the anatomical and functional outcome of autologous internal limiting membrane (ILM) transplant with 27-gauge plus (27G+) three ports pars plana vitrectomy (PPV) in failed and recurrent full-thickness macular holes (MH) in a spectrum of pathologies.

STUDY DESIGN

Observational cohort study Methods: Seven eyes of seven patients who had failed or recurrent MH were included from January 2017 to January 2022. A single vitreoretinal surgeon performed all surgeries using a 27G+ PPV system in a tertiary care hospital. An autologous ILM transplant was performed in each case, using hexafluoroethane or perfluoropropane as tamponade agents. The primary outcomes encompassed achieving MH closure, determining the best possible vision achieved during the 12-month follow-up period, and assessing any post-operative complications.

RESULTS

The average age of the patients enrolled in this study was 49.4 years. Four of the cohort of seven patients were male, while three were female. All individuals underwent successful surgery, with the closure of MH postoperatively. Swept-source optical coherence tomography was used to examine the closure of the MH on the first day after surgery, which was further validated by the absorption of gas. Over 12 months, the mean best corrected visual acuity in the logarithm of the minimum angle of resolution (Log MAR) improved significantly, progressing from 1.60 to 0.60. This favorable trend persisted throughout the 12-month follow-up, with MH remaining consistently closed. One patient encountered a subsequent retinal re-detachment, necessitating prompt and effective surgical intervention, resulting in successful management.

CONCLUSION

An autologous ILM transplant with a 27G+ PPV is a delicate and effective technique for closing MH in complicated cases. We recommend this technique for failed and recurrent MH in different pathologies.