J Korean Ophthalmol Soc.  2015 Dec;56(12):1899-1905. 10.3341/jkos.2015.56.12.1899.

Autologous Transplantation of Internal Limiting Membrane for the Treatment of Large Macular Hole

• Kim KH
• Jung JW
• Park SW
• Byon IS
• Lee JE

• KMID: 2148752
• DOI: http://doi.org/10.3341/jkos.2015.56.12.1899

Abstract

PURPOSE
To evaluate the surgical outcome of autologous transplantation of internal limiting membrane (ILM) for the treatment of large macular hole.
METHODS
Twenty-five gauge pars plana vitrectomy was performed for the treatment of patients with full thickness macular hole larger than 400 microm. ILM was stained using 0.025% brilliant blue G. ILM around the hole was circumferentially peeled as large as 2.5 disc diameter (DD) in size and then transplanted inside the hole. ILM was peeled out additionally approximately 1.5 DD in size. Fluid-air exchange and gas injection were performed. After surgery, the hole was scanned using spectral domain optical coherence tomography.
RESULTS
A total of 5 eyes were included in the present study. The mean age was 65.0 +/- 11.8 years (52-77) and mean best corrected visual acuity (log MAR) was 0.80 +/- 0.27. The mean refractive error was -2.0 +/- 2.2 diopter, mean horizontal size of hole was 701.4 +/- 129.4 microm, mean vertical size was 630.2 +/- 202.8 microm, mean hole base size was 1,043.4 +/- 225.0 microm and hole height was 464.4 +/- 218.9 microm. At the first day after surgery, transplanted ILM was detected inside the hole in all 5 eyes and complete closure of the hole occurred in 4 eyes. One hole was closed between postoperative days 4 and 7. Foveal contour improved gradually but photoreceptor integrity did not during the follow-up period. Two eyes showed visual improvement but 3 did not after surgery.
CONCLUSIONS
Macular hole was closed successfully and quickly using the autologous ILM transplantation technique. Based on our results, the autologous ILM should be considered the treatment of choice for large macular holes.

Keyword

Autologous internal limiting membrane implantation; Macular hole

MeSH Terms

Autografts*
Follow-Up Studies
Humans
Membranes*
Refractive Errors
Retinal Perforations*
Tomography, Optical Coherence
Transplantation, Autologous*
Visual Acuity
Vitrectomy

Figure

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  Figure 1. Fundus image during the autologous transplantation of the internal limiting membrane (ILM). ILM stained by 0.025% Brilliant Blue G dye was placed in the macula hole (white arrow).

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  Figure 2. A case of full thickness macular hole (MH) in 52-year-old female. Preoperative color fundus photograph (A) and OCT (B, horizontal white line: 1 mm scale bar) of the right eye demonstrated diabetic retinopathy and large macular hole. One day after sur-gery, transplanted internal limiting membrane was seen inside hole (white arrow), MH was closed (C). At 3 months, type 1 closure of hole was detected in OCT scan image. Snellen vision improved from 0.1 to 0.4 (D). OCT = optical coherence tomography.

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  Figure 3. A case of closure of a macular hole (MH) in 54-year-old female. Preoperative color fundus photograph (A) and optical co-herence tomography (OCT) (B, horizontal white line: 1 mm scale bar) shows the full thickness MH with perifoveal cyst. One day after surgery, the MH had closed and transplanted inner limiting membrane is seen inside the hole (white arrow) (C). At 1 month, OCT scan shows type 1 closure MH (D).

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  Figure 4. A case in 76-year-old male. Preoperative color fundus photograph (A) and optical coherence tomography (OCT) (B, hori-zontal white line: 1 mm scale bar) showing the multiple soft drusen and the large macular hole. At 6 months, OCT scan image showed the improvement of foveal configuration (type 1 closure of hole), but photoreceptor layer remained disrupted (C). His snell-en vision slightly improved from 0.1 to 0.15.

Reference

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