Autologous Retinal Transplantation for Primary and Refractory Macular Holes and Macular Hole Retinal Detachments: The Global Consortium

Stavros N. Moysidis, Nicole Koulisis, Sean D. Adrean, Steve Charles, Naren Chetty, Jay Kumar Chhablani, Javier Cisneros Cortes, Sherif N. Embabi, Carmelina Gordon, Ninel Z. Gregori, Ahmed Habib, Hany Hamza, Hisham Hassaan, Tarek S. Hassan, Odette Houghton, Kazuaki Kadonosono, Shunji Kusaka, Alberto La Mantia, Chi Chun Lai, Xhevat LumiTakatoshi Maeno, Mohamed Moghazy Mahgoub, Samir Mohamed El Baha, Virgilio Morales-Cantón, Mohamed Nowara, Ogugua Ndubuisi Okonkwo, Barbara Parolini, Flavio A. Rezende, Izabela Rogalinska, Sergio Rojas, David H. Steel, Marcin Stopa, An Lun Wu, Keiko Yamada, Mitsunori Yamada, Tamer H. Mahmoud

Research output: Contribution to journalArticlepeer-review

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Abstract

Purpose: To report the anatomic and functional outcomes of autologous retinal transplantation (ART). Design: Multicenter, retrospective, interventional, consecutive case series. Participants: One hundred thirty eyes of 130 patients undergoing ART for the repair of primary and refractory macular holes (MHs), as well as combined MH-rhegmatogenous retinal detachment (MH-RRD), between January 2017 and December 2019. Methods: All patients underwent pars plana vitrectomy and ART, with surgeon modification of intraoperative variables. A large array of preoperative, intraoperative, and postoperative data was collected. Two masked reviewers graded OCT images. Multivariate statistical analysis and subgroup analysis were performed. Main Outcome Measures: Macular hole closure rate, visual acuity (VA), external limiting membrane and ellipsoid zone (EZ) band integrity, and alignment of neurosensory layers (ANL) on OCT. Results: One hundred thirty ART surgeries were performed by 33 vitreoretinal surgeons worldwide. Patient demographics were: mean age of 63 ± 6.3 years, 58% female, 41% White, 23% Black, 19% Asian, and 17% Latino. Preoperative VA was 1.37 ± 0.12 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, approximately 20/500), which improved significantly to 1.05 ± 0.09 logMAR (Snellen equivalent, approximately 20/225; P < 0.001) after surgery (mean follow-up, 8.6 ± 0.8 months). Autologous retinal transplantation was performed for primary MH repair in 27% of patients (n = 35), for refractory MH in 58% of patients (n = 76; mean number of previous surgeries, 1.6 ± 0.2), and for MH-RRD in 15% of patients (n = 19). Mean maximum MH diameter was 1470 ± 160 μm, mean minimum diameter was 840 ± 94 μm, and mean axial length was 24.6 ± 3.2 mm. Overall, 89% of MHs closed (78.5% complete; 10% small eccentric defect), with a 95% closure rate in MH-RRD (68.4% complete; 26.3% small eccentric defect). Visual acuity improved by at least 3 lines in 43% of eyes and by at least 5 lines in 29% of eyes. Reconstitution of the EZ (P = 0.02) and ANL (P = 0.01) on OCT were associated with better final VA. Five cases of ART graft dislocation (3.8%), 5 cases of postoperative retinal detachment (3.8%), and 1 case of endophthalmitis (0.77%) occurred. Conclusions: In this global experience, patients undergoing ART for large primary and refractory MHs and MH-RRDs achieved good anatomic and functional outcomes, with low complication rates despite complex surgical pathologic features.

Original languageEnglish (US)
Pages (from-to)672-685
Number of pages14
JournalOphthalmology
Volume128
Issue number5
DOIs
StatePublished - May 2021

Keywords

  • Anteroposterior and tangential traction
  • Autologous retinal transplantation of neurosensory graft
  • Donor
  • Graft integration
  • High myopia
  • Host
  • Internal limiting membrane peel and flap
  • Macular hole
  • OCT
  • OCT angiography
  • Pathologic myopia
  • Rhegmatogenous retinal detachment

ASJC Scopus subject areas

  • Ophthalmology

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