PURPOSE To report the structural and functional outcomes of autologous neurosensory retinal transplant for closure of refractory large macular holes (MHs). DESIGN Multicenter, retrospective, consecutive case series. PARTICIPANTS A total of 41 eyes of 41 patients with a full-thickness MH refractory to prior vitrectomy with internal limiting membrane (ILM) peel and tamponade. METHODS All patients underwent pars plana vitrectomy, autologous neurosensory retinal transplant with gas, silicone oil tamponade, or short-term perfluoro-n-octane heavy-liquid tamponade. All patients had at least 6 months' follow-up. MAIN OUTCOME MEASURES Anatomic closure of MH, change in ellipsoid zone (EZ) and external limiting membrane (ELM) defect on OCT, visual acuity (VA) recovery, and surgical complications were analyzed. RESULTS Mean number of prior surgeries was 1.5±0.94 (range, 1-3), and patients were followed for a mean of 11.1±7.7 months (range, 6-36 months). Complete anatomic closure of MH by OCT was achieved in 36 of 41 eyes (87.8%). Mean corrected VA (logarithm of the minimum angle of resolution [logMAR]) improved (P = 0.03) from 1.11±0.66 (range, 0.48-3) to 1.03±0.51 (range, 0.1-2) at the last postoperative visit. The VA improved (≥0.3 logMAR units) in 15 eyes (36.6%), was stable in 17 eyes (41.5%), and worsened in 9 eyes (21.9%). Among eyes with anatomic closure, VA improved in 52.3% and worsened in 13.8%, whereas in those without closure, VA worsened in 40% and improved in none. Mean preoperative largest basal diameter was 1468.1±656.4 μm (range, 621-2600 μm), and mean inner-opening diameter was 825±422.5 μm (range, 336-1649 μm). Mean preoperative EZ defect was 1777.3±513.8 μm (range, 963-2808 μm), which decreased to 1370±556.9 μm (range, 288-2000 μm) at final follow-up (P = 0.007). Mean preoperative ELM was 1681.5±429 μm (range, 1172-2606 μm), which decreased to 1408.5±571.2 μm (range, 200-2000 μm) at final follow-up (P = 0.017). Major postoperative complications were retinal detachment (n = 1) and vitreous hemorrhage (n = 1). There were no cases of proliferative vitreoretinopathy, endophthalmitis, suprachoroidal hemorrhage, or choroidal neovascularization. CONCLUSIONS The autologous retinal transplant technique offers a high degree of anatomic success and proved safe in this initial experience for closure of refractory MHs.

中文翻译：

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难治性黄斑裂孔的自体视网膜移植：多中心国际合作研究小组。

目的报告自体神经感觉性视网膜移植治疗难治性大黄斑裂孔（MHs）的结构和功能结果。设计多中心，回顾性，连续案例系列。参加者：41例全玻璃厚度MH且先前玻璃体切除术难以治愈并伴有内部限制膜（ILM）剥离和填塞的患者，共41眼。方法所有患者均进行了平面玻璃体切除术，自体神经感觉性视网膜移植术，气体，硅油填塞剂或短期全氟正辛烷重液填塞剂。所有患者均接受了至少6个月的随访。主要观察指标分析了MH的解剖闭合，OCT上椭圆区（EZ）和外部限制膜（ELM）缺损的变化，视力（VA）的恢复以及手术并发症。结果既往手术的平均次数为1.5±0.94（范围为1-3），患者的平均随访时间为11.1±7.7个月（范围为6-36个月）。41眼中有36眼（87.8％）通过OCT实现了MH的完全解剖闭合。在最后一次术后访视时，平均校正后的VA（最小分辨角[logMAR]的对数）从1.11±0.66（范围0.48-3）提高到1.03±0.51（范围0.1-2）（P = 0.03）。15眼（36.6％）的VA改善（≥0.3 logMAR单位），17眼（41.5％）稳定，9眼（21.9％）恶化。在有解剖性闭合的眼中，VA改善了52.3％，而恶化了13.8％，而在没有闭合性的眼中，VA恶化了40％，而无改善。术前平均最大基底直径为1468.1±656.4μm（范围621-2600μm），平均内开口直径为825±422.5μm（范围336-1649μm）。术前EZ缺损平均为1777.3±513.8μm（范围963-2808μm），在最终随访时降低至1370±556.9μm（范围288-2000μm）（P = 0.007）。术前平均ELM为1681.5±429μm（范围1172-2606μm），在最终随访时降至1408.5±571.2μm（范围200-2000μm）（P = 0.017）。术后主要并发症为视网膜脱离（n = 1）和玻璃体出血（n = 1）。没有增生性玻璃体视网膜病变，眼内炎，脉络膜上出血或脉络膜新生血管形成的病例。结论自体视网膜移植技术在解剖学上取得了成功，并且在这种难治性MH封闭的初步经验中被证明是安全的。术前平均ELM为1681.5±429μm（范围1172-2606μm），在最终随访时降至1408.5±571.2μm（范围200-2000μm）（P = 0.017）。术后主要并发症为视网膜脱离（n = 1）和玻璃体出血（n = 1）。没有增生性玻璃体视网膜病变，眼内炎，脉络膜上出血或脉络膜新生血管形成的病例。结论自体视网膜移植技术在解剖学上取得了成功，并且在这种难治性MH封闭的初步经验中被证明是安全的。术前平均ELM为1681.5±429μm（范围1172-2606μm），在最终随访时降至1408.5±571.2μm（范围200-2000μm）（P = 0.017）。术后主要并发症为视网膜脱离（n = 1）和玻璃体出血（n = 1）。没有增生性玻璃体视网膜病变，眼内炎，脉络膜上出血或脉络膜新生血管形成的病例。结论自体视网膜移植技术在解剖学上取得了成功，并且在这种难治性MH封闭的初步经验中被证明是安全的。眼内炎，脉络膜上出血或脉络膜新生血管形成。结论自体视网膜移植技术在解剖学上取得了成功，并且在关闭难治性MH的最初经验中被证明是安全的。眼内炎，脉络膜上出血或脉络膜新生血管形成。结论自体视网膜移植技术在解剖学上取得了成功，并且在这种难治性MH封闭的初步经验中被证明是安全的。