Original article
Autologous Transplantation of the Internal Limiting Membrane for Refractory Macular Holes

https://doi.org/10.1016/j.ajo.2013.12.028Get rights and content

Purpose

To determine the effectiveness of autologous transplantation of the internal limiting membrane (ILM) for refractory macular holes.

Design

Prospective, interventional case series.

Patient and Methods

Ten eyes of 10 consecutive patients who underwent autologous transplantation of the ILM for the treatment of refractory macular holes were studied. The primary diseases in these patients were large idiopathic macular holes that had existed for more than 1 year (4 eyes), a traumatic macular hole (1 eye), myopic foveoschisis (2 eyes), foveoschisis resulting from pit-macular syndrome (2 eyes), and proliferative diabetic retinopathy (1 eye). Apart from the 5 eyes with idiopathic or traumatic macular holes, macular holes developed in the other 5 eyes after initial vitrectomies with ILM removal. In all eyes, regular macular hole surgery failed to achieve closure. The main outcome measures used in this study were macular hole closure and best-corrected visual acuity (BCVA).

Results

Macular holes were closed successfully in 9 eyes (90%) after autologous transplantation of the ILM. The postoperative BCVAs were significantly better than the preoperative BCVAs (P = .007, paired t test). Postoperative BCVAs improved by more than 0.2 logarithm of the minimal angle of resolution units in 8 eyes (80%) and were unchanged in 2 eyes (20%).

Conclusions

Although this is a pilot study, the results suggest that autologous transplantation of the ILM may contribute to improved anatomic and visual outcomes in the treatment of refractory macular holes and may warrant further investigation.

Section snippets

Patients and Study Design

This study was a prospective, interventional case series. All investigations adhered to the tenets of the Declaration of Helsinki. Each patient was informed about the risks and benefits of the surgery and their written, informed consent was obtained. The study was approved by the Institutional Review Boards of Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Kagawa University Faculty of Medicine.

Ten eyes of 10 consecutive patients who had refractory

Results

The characteristics of the 10 patients who were enrolled in this study are shown in the Table. The mean age of the 6 female and 4 male patients was 60.6 ± 19.5 years (range, 17 to 83 years). The mean follow-up period was 12 ± 5 months (range, 3 to 18 months). The mean diameter of the macular holes before autologous transplantation of the ILM was 509.3 ± 137.8 μm (range, 281 to 789 μm). The lens status of the eyes was unchanged after autologous transplantation of the ILM. Intraocular lenses had

Discussion

Recently, several surgical procedures that intentionally spare the foveal ILM have been reported to be effective in conditions such as large macular holes, myopic macular holes, and myopic foveoschisis.2, 3, 4, 5 Although these procedures can be options for the initial vitrectomy, to avoid the failure of macular hole closure and the development of secondary macular holes, they cannot be the solution for eyes with macular holes from which the ILMs already have been removed in previous

Yuki Morizane, MD, PhD, is an Assistant Professor (Lecturer), Department of Ophthalmology, Okayama University, Okayama, Japan. After finishing his residency in ophthalmology and retina fellowship at Okayama University Hospital, he completed a retinal research fellowship at Harvard Medical School, Massachusetts Eye and Ear Infirmary from 2008 to 2011. His research interests are metabolic mechanisms of ocular diseases, ocular neovascularization, and vitrectomy.

References (29)

  • A. Almony et al.

    Techniques, rationale, and outcomes of internal limiting membrane peeling

    Retina

    (2012)
  • Z. Michalewska et al.

    Inverted internal limiting membrane flap technique for large macular holes

    Ophthalmology

    (2010)
  • S. Kuriyama et al.

    Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia

    Am J Ophthalmol

    (2013)
  • N. Shimada et al.

    Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy

    Am J Ophthalmol

    (2012)
  • T.-C. Ho et al.

    Foveola nonpeeling technique in internal limiting membrane peeling of myopic foveoschisis surgery

    Retina

    (2012)
  • H. Kobayashi et al.

    Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis

    Ophthalmology

    (2003)
  • S.W. Kang et al.

    Types of macular hole closure and their clinical implications

    Br J Ophthalmol

    (2003)
  • J. Hillenkamp et al.

    Retreatment of full-thickness macular hole: predictive value of optical coherence tomography

    Br J Ophthalmol

    (2007)
  • H.Y. Cho et al.

    Laser photocoagulation as adjuvant therapy to surgery for large macular holes

    Korean J Ophthalmol

    (2006)
  • S. Alpatov et al.

    A new method of treating macular holes

    Eur J Ophthalmol

    (2007)
  • S.E. Hernandez-Da Mota

    Posttraumatic giant macular hole

    Case Rep Ophthalmol

    (2011)
  • J. Huang et al.

    Comparison of full-thickness traumatic macular holes and idiopathic macular holes by optical coherence tomography

    Graefes Arch Clin Exp Ophthalmol

    (2010)
  • J.F. Arevalo et al.

    Optical coherence tomography characteristics of full-thickness traumatic macular holes

    Eye (Lond)

    (2008)
  • T. Yamashita et al.

    Spontaneous closure of traumatic macular hole

    Am J Ophthalmol

    (2002)

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    Yuki Morizane, MD, PhD, is an Assistant Professor (Lecturer), Department of Ophthalmology, Okayama University, Okayama, Japan. After finishing his residency in ophthalmology and retina fellowship at Okayama University Hospital, he completed a retinal research fellowship at Harvard Medical School, Massachusetts Eye and Ear Infirmary from 2008 to 2011. His research interests are metabolic mechanisms of ocular diseases, ocular neovascularization, and vitrectomy.

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