Autologous neurosensory retinal transplantation for large refractory idiopathic macular hole.

[PURPOSE] To investigate the structural and functional reconstruction of the macula after autologous neurosensory retinal-free flap transplantation (ANRFFT) in eyes with large refractory idiopathic macular holes (IMHs).

[METHODS] Patients with refractory IMHs after multiple surgeries who underwent ANRFFT were retrospectively reviewed. The main outcomes were anatomic closure of MH, change in external limiting membrane (ELM) defect on optical coherence tomography (OCT) and best-corrected visual acuity (BCVA).

[RESULTS] A total of 7 patients (4 female and 3 male; mean age 60.6 ± 8.6 years) were included in the study. Mean preoperative largest basal diameter was 1146.7 ± 413.7 µm (range, 653-1768 µm), and mean narrowest inner-opening diameter was 788.9 ± 148.8 µm (range, 644-1100 µm). Mean BCVA (logarithm of the minimum angle of resolution [logMAR]) significantly improved from 1.53 ± 0.16 (range, 1.3-1.7) to 0.89 ± 0.23 (range, 0.6-1.3) at the final follow-up (P < 0.001). OCT revealed complete closure of MH in all eyes. Mean preoperative ELM defect significantly decreased from 1450.3 ± 306.5 µm (range, 1044-1908 mm) to 533.1 ± 399.2 µm (range, 0-1156 µm, P = 0.001). Postoperative complications included retinal detachment (n = 1), cystoid macular edema like changes in the graft (n = 1) and reactive pigment epithelial hyperplasia (n = 1).

[CONCLUSION] Although some postoperative complications did occur, ANRFFT seems to be an effective treatment for large refractory IMHs, and can promote recovery of the outer retinal structure resulting in functional improvement.