Autologous internal limiting membrane transplantation achieves anatomic closure and functional improvement in the treatment of large, persistent macular holes.

PURPOSE: To evaluate the clinical outcome of subretinal autologous internal limiting membrane (ILM) transplantation during pars-plana vitrectomy for persistent full-thickness macular hole (FTMH) repair. METHODS: Retrospective, consecutive case series of 13 eyes (13 patients) undergoing small-incision vitrectomy with ILM transplantation and air tamponade for large persistent FTMH after prior unsuccessful vitrectomy with posterior hyaloid detachment and ILM peeling. MAIN OUTCOME MEASUREMENTS: For all eyes, high-definition spectral domain optical coherence tomography scans (SD-OCT Spectralis, Heidelberg Engineering GmbH, Germany) of the macula were routinely performed before surgery, 1 and 4 weeks after surgery, and at the final follow-up visit. Additionally, age, gender, axial length, macular hole diameter, biomicroscopic fundus evaluation and best-corrected visual acuity (BCVA) at baseline, 1 and 4 weeks after surgery, and at the final follow-up visit were analyzed. RESULTS: Anatomic closure was achieved in all 13 cases (100% success rate). Closure pattern was classified in accordance with to Rossi et al. (Graefe's Arch Clin Exp Ophthalmol 258(12):2629-2638, 2020). Mean baseline BCVA logMAR was 0.93, mean postoperative BCVA logMAR was 0.66 with a mean postoperative follow-up period of 11.4 months. No re-opening occurred during the observation period. CONCLUSIONS: Placing an autologous ILM-transplant in the subretinal space beneath the margin of the FTMH can support anatomic restauration and functional improvement in large, persistent FTMHs.

Clinical study of macular structure and choroidal thickness after different treatments / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the effects of internal limiting membrane transplantation, inverted internal limiting membrane flap and autologous blood filling in treatment of idiopathic macular hole(IMH)and the influence on macular structure and choroidal thickness.<p>METHODS: Clinical data of patients with IMH who were treated in the hospital between January 2017 and December 2019 were retrospectively analyzed. All patients were treated with standard vitrectomy combined with internal limiting membrane stripping and gas-liquid exchange. On this basis, patients treated with internal limiting membrane transplantation(28 cases, 29 eyes), inverted internal limiting membrane flap(26 cases, 28 eyes)and autologous blood filling(25 cases, 25 eyes)were included in the internal limiting membrane transplantation group, inverted internal limiting membrane flap group and autologous blood filling group, respectively. The situation of hole closure and shape of the closed hole were observed. The best corrected visual acuity(BCVA), hole photoreceptors inner segment/outer segment ellipsoid zone(EZ)and external limiting membrane(ELM)defect diameter, perimeter of foveal avascular zone(PERIM), superficial capillary plexus(SCP)blood flow density, subfoveal choroidal thickness(SFCT), temporal choroidal thickness(TCT)and nasal choroidal thickness(NCT)were determined. <p>RESULTS: All patients in the 3 groups successfully completed the surgery. The BCVA of internal limiting membrane transplantation group and inverted internal limiting membrane flap group was better than that of autologous blood filling group at 3mo after surgery(<i>P</i><0.05). There were no significant differences in macular hole closure rate and ellipsoid closure rate among the 3 groups(<i>P</i>>0.05). However, there were significant differences in morphological classification of the closed macular hole(<i>P</i><0.05), and the proportion of U-shaped hole was the highest in inverted internal limiting membrane flap group. The diameters of EZ defect and ELM defect of internal limiting membrane transplantation group and inverted internal limiting membrane flap group were smaller than those of autologous blood filling group at 3mo after surgery(<i>P</i><0.05). There were no significant differences in PERIM, SCP blood flow density, SFCT, TCT and NCT among the 3 groups before and after surgery(<i>P</i>>0.05). <p>CONCLUSION:Internal limiting membrane transplantation, inverted internal limiting membrane flap and autologous blood filling can restore the closure of the macular hole. However, internal limiting membrane transplantation and inverted internal limiting membrane flap can better restore the macular structure and improve visual acuity, compared with autologous blood filling.

Evaluation of Vision-Related Quality of Life after Autologous Internal Limiting-Membrane Transplantation for Refractory Macular Holes.

PURPOSE: To evaluate the vision-related quality of life of vitrectomy combined with autologous internal limiting membrane (ILM) transplantation for refractory macular holes (MHs). METHODS: There were 40 eyes with refractory MHs included, and all eyes received 23 G vitrectomy and ILM peeling with autologous ILM transplantation. Preoperative and postoperative basic conditions were recorded. The Chinese version of the vision-related quality-of-life scale was used to evaluate patients after operation. Quality of life, postoperative visual acuity, and size of MHs before operation were assessed with Spearman rank correlations. RESULTS: All patients were followed up for 3 months after surgery. Mean postoperative best-corrected visual acuity had significantly improved after surgery. Vision-related quality of life of patients after surgery was closely related to the MH index, but negatively correlated with best-corrected visual acuity before and after surgery. CONCLUSION: The anatomical structure of refractory MHs with ILM peeling combined with autologous ILM transplantation was largely reduced, and the visual acuity of patients improved significantly.

Effect of internal limiting membrane peeling and transplantation on vision-related quality of life in refractory macular hole / 中华眼底病杂志

Objective@#To observe the effect of internal limiting membrane peeling and transplantation on vision-related quality of life in refractory macular hole.@*Methods@#A retrospective clinical study. Thirty patients (30 eyes) with refractory macular hole diagnosed in Ophthalmology Department of The First Affiliated Hospital of Nanjing Medical University from January to December 2016 were included in this study. There were 13 males (13 eyes) and 17 females (17 eyes), with the mean age of 57.3±6.9 years. There were 15 patients(15 eyes) with large macular diameter, 12 patients (12 eyes) with high myopia macular hole, and 3 patients (3 eyes) with secondary traumatic macular hole. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. OCT was performed to measure the macular retinal thickness (CRT), base diameter and minimum diameter of macular hole. Then, the macular hole index(MHI) was calculated. The logMAR BCVA was 1.52±0.30, MHI was 0.51±0.19. The Chinese version of visual-related quality of life scale-25 (CVRQoL-25) was used to evaluate the vision-related quality of life of patients. The CVRQoL-25 score was 57.60±7.13. All patients underwent 23G vitrectomy combined with inner limited membrane peeling and autologous ILM transplantation. The follow-up was at least 3 months after surgery. The changes of BCVA, MHI, CRT and CVRQoL-25 score before and after surgery were comparatively analyzed. Paired t test was performed to compare the measurement data before and after surgery, and Spearman rank correlation analysis was used for the correlation analysis among the parameters.@*Results@#At 3 months after surgery, the hole closure was detected in 28 eyes (93.3%), not detected in 2 eyes (6.7%). The logMAR BCVA was 1.16±0.33, CRT was 161.00±15.26, and CVRQoL-25 scores was 70.83±9.77. Compared with before surgery, the BCVA (t=4.386, P=0.000) and CVRQoL-25 score (t=-5.991, P=0.000) after surgery were improved. Spearman rank correlation analysis showed that CVRQoL-25 score was negatively correlated with preoperative and postoperative logMAR BCVA (r=−0.536, −0.796; P=0.002, 0.000); positively correlated with preoperative MHI (r=0.421, P=0.020) and postoperative CRT (r=0.589, P=0.001).@*Conclusion@#Internal limiting membrane peeling and transplantation for refractory macular hole can significantly improve the vision-related quality of life and visual acuity, while achieved a high hole closure rate (93.3%).

Effect of internal limiting membrane peeling and transplantation on vision-related quality of life in refractory macular hole / 中华眼底病杂志

Objective To observe the effect of internal limiting membrane peeling and transplantation on vision-related quality of life in refractory macular hole.Methods A retrospective clinical study.Thirty patients (30 eyes) with refractory macular hole diagnosed in Ophthalmology Department of The First Affiliated Hospital of Nanjing Medical University from January to December 2016 were included in this study.There were 13 males (13 eyes) and 17 females (17 eyes),with the mean age of 57.3 ± 6.9 years.There were 15 patients (15 eyes) with large macular diameter,12 patients (12 eyes) with high myopia macular hole,and 3 patients (3 eyes) with secondary traumatic macular hole.The BCVA examination was performed using the Snellen visual acuity chart,which was converted into logMAR visual acuity.OCT was performed to measure the macular retinal thickness (CRT),base diameter and minimum diameter of macular hole.Then,the macular hole index (MHI) was calculated.The logMAR BCVA was 1.52±0.30,MHI was 0.51 ±0.19.The Chinese version of visual-related quality of life scale-25 (CVRQoL-25) was used to evaluate the vision-related quality of life of patients.The CVRQoL-25 score was 57.60±7.13.All patients underwent 23G vitrectomy combined with inner limited membrane peeling and autologous ILM transplantation.The follow-up was at least 3 months after surgery.The changes ofBCVA,MHI,CRT and CVRQoL-25 score before and after surgery were comparatively analyzed.Paired t test was performed to compare the measurement data before and after surgery,and Spearman rank correlation analysis was used for the correlation analysis among the parameters.Results At 3 months after surgery,the hole closure was detected in 28 eyes (93.3％),not detected in 2 eyes (6.7％).The logMAR BCVA was 1.16± 0.33,CRT was 161.00± 15.26,and CVRQoL-25 scores was 70.83 ± 9.77.Compared with before surgery,the BCVA (t=4.386,P=0.000) and CVRQoL-25 score (t=-5.991,P=0.000) after surgery were improved.Spearman rank correlation analysis showed that CVRQoL-25 score was negatively correlated with preoperative and postoperative logMAR BCVA (r=-0.536,-0.796;P=0.002,0.000);positively correlated with preoperative MHI (r=0.421,P=0.020) and postoperative CRT (r=0.589,P=0.001).Conclusion Internal limiting membrane peeling and transplantation for refractory macular hole can significantly improve the vision-related quality of life and visual acuity,while achieved a high hole closure rate (93.3％).

Treatment of refractory giant macular hole by vitrectomy with internal limiting membrane transplantation and autologous blood.

AIM: To investigate the effect of internal limiting membrane transplantation and autologous blood on treating refractory giant macular hole. METHODS: Thirty-seven eyes with giant macular hole of the smallest hole diameter >700 µm, the maximum diameter of the substrate >1000 µm and hole formation factor <0.6 underwent surgical treatment. The patients were randomly divided into two groups. Nineteen eyes with surgical flip of the internal limiting membrane in group A, 18 eyes with internal limiting membrane transplantation in group B who underwent the tamponade of internal limiting membrane into the hole, autologous plasma was used to seal the hole. The patients were followed up for 3mo, optical coherence tomography and best corrected visual acuity (BCVA) were recorded before and after operation, and the results were statistically analyzed. RESULTS: At 3mo after operation, BCVA of the two groups was significantly improved compared with that before operation (tA=4.192, tB=4.374, P<0.05). But there was no significant difference in visual acuity between the two groups (χ2=0.128, P>0.05). At 3mo after operation, the closure rate of group A was 68.4%, and 100% in group B. (χ2=5.628, P<0.05). The defect diameter of inner segment/outer segment at 3mo after the operation was significantly lower than that before operation (tA=12.287, tB=15.481, P<0.05), and the difference was statistically significant (t=2.552, P<0.05). CONCLUSION: Internal limiting membrane transplantation combined with autologous whole blood can improve the postoperative closure rate of the refractory large aperture, and can effectively improve the postoperative visual acuity.

Autologous Internal Limiting Membrane Transplants Successfully Close a Large Parafoveal Retinal Hole.

　Parafoveal retinal holes (PRHs) are one of the complications that can occur after internal limiting membrane (ILM) peeling during macular surgery. Here we describe a patient in whom an exceptionally large PRH (1,069-µm dia.) was successfully closed by repeated autologous ILM transplantation.

Clinical efficacy evaluation of vitrectomy combined with autologous internal limiting membrane transplantation for large macular hole / 中华实验眼科杂志

Background Giant idiopathic macular hole (IMH) severely affects visual acuity and increases operative difficulty during the surgery,so modifying or optimizing the operation method is helpful for improving the prognosis.Objective This study aimed to evaluate the efficacy and safty of vitrectomy combined with free internal limiting membrane transplantation for large IMH.Methods A prospective serial cases-observational study was carried out under the informed consent of each patient.Forty-two eyes of consecutive 42 patients with IMH of mean diameter (814.31±112.95)μm were included in the Second Hospital of Hebei Medical University from January 2013 to November 2015.All the eyes received vitrectomy combined with free internal limiting membrane transplantation and 12％ C3F8 filling.The best corrected visual acuity (BCVA) (LogMAR),inner segment/outer segment (IS/OS) defect range,external limiting membrane defect range,retinal thickness at macular fovea were measured with slit lamp microscope,indirect ophthalmoscope and spectral-domain optical coherence tomography (SD-OCT) before surgery and 1,3,6 and 12 months after surgery.Results IMH complete closure in 97.6％ eyes (41/44) at 12 months after surgery.BCVA was improved after operation and showed a significant difference among various time points (F =28.032,P＜0.001).The IS/OS defect range was (1 112.00±45.44),(859.00±84.55),(649.00±52.47),(486.00±46.88) and (320.00±45.13) μm before surgery and 1,3,6 and 12 months after surgery,showing a significant difference among different time points (F=38.761,P＜0.001),and the IS/OS defect range was gradually shrinked after operation compared with that before operation (all at P＜0.05).The mean defect range of external limiting membrane was (1 038.00 ±39.63),(748.00±64.12),(585.00±48.88),(438.00±42.84) and (265.00±28.97)μm before surgery and 1,3,6 and 12 months after surgery,with a significant difference among various time points (F=36.459,P＜0.001),and the mean defect range of external limiting membrane was evidently reduced (all at P＜0.05).The foveal retinal thickness value was increased at 3,6 and 12 months after surgery,which was significantly higher than that 1 month after surgery (all at P＜0.05).The high reflect signal was faded away at 3 months after operation,indicating that implanted internal limiting membrane was decomposed and metabolized.Conclusions Vitrectomy combined with autologous internal limiting membrane transplantation seems to be safe and effective for large IMH.

Hyper-proliferation of Glial Tissues Following Autologous Internal Limiting Membrane Transplantation in Idiopathic Large Macular Holes

PURPOSE: To report three cases of glial hyper-proliferation after autologous internal limiting membrane (ILM) transplantation in idiopathic large macular holes. CASE SUMMARY: Three eyes with full thickness macular holes >500 µm underwent autologous ILM transplantation. After surgery, the macular hole was closed and foveal contour was U-shaped. Optical coherence tomography revealed long-lasting proliferation of glial cells in the fovea after the hole closure. This glial proliferation continued for 6 months, with improved visual acuity, and bump-like features of the fovea. CONCLUSIONS: Autologous transplantation of ILM effectively induced long-lasting proliferation of glial cells, thereby achieving the closure of large macular holes. However, an abnormality of the foveal contour may develop after the hole closure in some cases.