Autologous full-thickness retinal transplant for refractory large macular holes
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GINAL ARTICLE
International Journal of Retina and Vitreous Open Access
Autologous full-thickness retinal transplant for refractory large macular holes Sergio Rojas‑Juárez1, Javier Cisneros‑Cortés1, Abel Ramirez‑Estudillo1 and Raul Velez‑Montoya2*
Abstract Background: Despite the constant refinement of techniques and surgical aids, extremely large and refractory macu‑ lar holes continue to have poor surgical outcomes with the current standard of care. The objective of the present study is to assess the anatomical and functional outcomes, as well as the structural change through time, of the opti‑ cal coherence tomography of patients with refractory macular holes treated with a full-thickness autologous retinal transplant. Methods: Prospective, case series. We include patients with a clinical diagnosis of refractory macular holes with a minimum diameter of at least 500 µm. All the patients had a comprehensive ophthalmological examination, which included a best-corrected visual acuity assessment, fundus examination, and optical coherence analysis. All the patients underwent a 23-gauge pars plana vitrectomy with a full-thickness retinal transplant and silicone oil tampon‑ ade (5000 cs 500 µm) and a history of at least 1 previous failed macular hole surgery. We excluded patients with past medical history relevant for amblyopia, diabetic retinopathy, diabetic macular edema, advanced glaucoma, age-related macular degeneration, and other macular diseases. After enrollment, all the patients underwent a comprehensive ophthalmological examination which included assessment of the best-corrected visual acuity (BCVA), measured as the logarithm of the minimum angle of resolution (logMAR), slit lamp examination, fundus examination and optical coherence tomography (OCT, Spectralis
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HRA-OCT; Heidelberg Engineering, Heidelberg, Germany). The OCT images were acquired using a preset 7 Line Raster Scan of 30° × 0°, 25 frames OCT ART mean and 240-µm spacing on high resolution. If the scan was not centered, the aiming beam was manually placed in the center of the macular hole in order to ensure that the fourth of the 7 lines passed in the middle of the foveal defect. The fourth raster line was used for all measurements. From each OCT study, we assessed the integrity of the different main retinal layers, myoid and ellipsoid layers, and the Bruch-retinal pigment epithelium-choriocapillaris complex. The minimum diameter (minimal extent of the hole) and the base diameter (diameter at the level of the retinal pigment epithelium), as well as the gap defect at the level of the myoid/ellipsoid layer, were manually assessed with the measuring tool built into the software by a single observer (JCC). All the patients had standard 23-gauge, three-port, pars plana vitrectomy (PPV) and silicone oil tamponade. All the surgeries were performed by a senior attending physician (SRJ) with the Constellation platform (Alcon Labs, Fort Worth TX, US). After the revision of the retinal periphery and removal of remaining vitreous gel, the macula
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