Anatomical and Functional Efficiency of a Modified Method of Autologous Retinal Transplantation for Large Full-thickness Macular Holes

Purpose. To evaluate the anatomical and functional efficacy of a modified autologous retinal transplantation (ART) technique in the surgical treatment of large full-thickness macular holes (FTMH).
Material and Methods. The study included 41 patients (42 eyes) with a minimum FTMH diameter greater than 800 µm who had previously undergone vitrectomy with internal limiting membrane peeling and gas tamponade due to FTHM. Patients were divided into two groups. In the main group, a modified ART was performed using preoperative navigated flap planning, intraoperative optical coherence tomography guidance, and fixation with autologous platelet-rich plasma. In the control group, macular hole edges were closed using an aspiration technique followed by application of autologous platelet-rich plasma. Anatomical outcomes were assessed by optical coherence tomography, while functional outcomes included bestcorrected visual acuity and central retinal sensitivity. The follow-up period was 6 months.
Results. Stable anatomical closure of the FTMH was achieved in all cases in the main group. In the control group, macular hole recurrence was observed in 22 % of patients (p = 0.049). Both groups demonstrated a statistically significant improvement in best-corrected visual acuity and retinal sensitivity as early as 1 month postoperatively, with no significant intergroup differences in cases with successful anatomical closure.
Conclusions. Modified ART provides a higher and more stable anatomical success rate in the treatment of large FTMH compared with the edge approximation technique. Functional outcomes are characterized by early improvement followed by stabilization during follow-up.

1. Klein R, Klein BE, Wang Q, Moss SE. The epidemiology of epiretinal membranes. Trans Am Ophthalmol Soc. 1994;92:403–430.

2. Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol. 1991 May;109(5):654–659. doi: 10.1001/archopht.1991.01080050068031.

3. Samoĭlov AN, Khaibrakhmanov TR, Fazleeva GA, Samoylova PA. Idiopathic macular hole: history and status quo review. Russian Annals of Ophthalmology. 2017;133(6):131–137 (In Russ.). doi: 10.17116/oftalma20171336131-137.

4. Gupta D. Face-down posturing after macular hole surgery. A review. Retina. 2009;29(4):430–443. doi: 10.1097/IAE.0b013e3181a0bd01.

5. Jančo L, Vida R, Bartoš M. Chirurgická liečba idiopatickej diery makuly naše skúsenosti. [Surgical treatment of the idiopatic macular hole — our experience.] Cesk Slov Oftalmol. 2013;69(3):102–105 (In Czech).

6. Belyi YuA, Tereshchenko AV, Shkvorchenko DO. Surgical treatment of large idiopathic macular tears. Practical medicine. 2015;2:119–123 (In Russ.).

7. Rezende FA, Ferreira BG, Rampakakis E, Steel DH, Koss MJ, Nawrocka ZA, Bacherini D, Rodrigues EB, Meyer CH, Caporossi T, Mahmoud TH, Rizzo S, Johnson MW, Duker JS. Surgical classification for large macular hole: based on different surgical techniques results: the CLOSE study group. Int J Retina Vitreous. 2023;9(1):4. doi: 10.1186/s40942-022-00439-4.

8. Hoerauf H, Kluter H, Joachimmeyer E, Roider J, Framme C, Schlenke P, Kirchner H, Lagua H. Results of vitrectomy and the no-touch-technique using autologous adjuvants in macular hole treatment. Int Ophthalmol. 2001;24(3):151–159. doi:.10.1023/a:1021566806836.

9. Gaudric A, Massin P, Paques M, Santiago P-Y, Guez J-E, Le Gargasson J-F, Mundler O, Drouet L. Autologous platelet concentrate for the treatment of fullthickness macular holes. Graefes Arch Clin Exp Ophthalmol. 1995;233(9):549–554. doi: 10.1007/bf00404704.

10. Petrachkov DV, Alkharki L, Matyushchenko AG, Filippov VM, Dudieva FK. Comparison of Early Treatment Outcomes for Large Macular Hole Using Various Surgical Techniques. Ophthalmology in Russia. 2021;18(3S):681–687 (In Russ.). doi: 10.18008/1816-5095-2021-3S-681-687.

11. Yusef Yu, Petrachkov DV, Baryshev KV, Shabalina KN, Alharki L, Fedoruk NA, Filippov VM, Telyatov BA. Method for surgical treatment of large idiopathic fullthickness macular hole. Patent RU 2826123, 04.09.2024 (In Russ.).

12. Yusef Yu, Petrachkov DV, Baryshev KV, Alkharki L, Matyushchenko AG, Korobov EN, Filippov VM. Method for surgical treatment of large idiopathic full-thickness macular hole. Patent RU 2846215, 02.09.2025 (In Russ.).

13. Moysidis SN, Koulisis N, Adrean SD. Autologous Retinal Transplantation for Primary and Refractory Macular Holes and Macular Hole Retinal Detachments: The Global Consortium. Ophthalmology. 2021;128(5):672–685. doi: 10.1016/j.ophtha.2020.10.007.

14. Grewal DS, Charles S, Parolini B, Kadonosono K, Mahmoud TH. Autologous Retinal Transplant for Refractory Macular Holes: Multicenter International Collaborative Study Group. Ophthalmology. 2019; 126(10):1399–1408. doi: 10.1016/j.ophtha.2019.01.027.

15. Olufsen ME, Hannibal J, Soerensen NB. Autologous Neurosensory Retinal Flap Transplantation in a Porcine Model of Retinal Hole. Ophthalmol Sci. 2024;5(2):100644. doi: 10.1016/j.xops.2024.100644.