Autologous retinal transplant in the repair of refractory macular holes: assessment of anatomical and functional outcomes

Purpose The current study aims to evaluate the anatomical and visual outcomes of autologous neurosensory retinal transplantation (ART) in the management of refractory full-thickness macular holes unresponsive to previous vitrectomy with internal limiting membrane peeling. Patients and methods This prospective case series included 20 eyes of 20 patients who underwent pars plana vitrectomy with ART at the Research Institute of Ophthalmology, Egypt, between May 2020 and September 2022. All eyes had previously failed at least one internal limiting membrane peel. A neurosensory retinal graft was harvested from the midperipheral retina and transplanted under perfluoro-n-octane heavy liquid. Anatomical closure was assessed using spectral-domain optical coherence tomography. Visual outcomes were assessed via the best-corrected visual acuity. Results Anatomical closure was achieved in 13 (65%) eyes. In these eyes, mean best-corrected visual acuity significantly improved from 1.58±0.22 logMAR preoperatively to 1.18±0.29 logMAR postoperatively ( P =0.001). Successful restoration of the external limiting membrane and ellipsoid zone was observed, with mean defect lengths decreasing significantly ( P =0.002). Visual improvement of more than or equal to 3 ETDRS lines occurred in 53.8% of eyes with closed holes, and no eye experienced postoperative visual decline. Major complications were retinal detachment in 25% of eyes, graft dislocation (5%), and intractable glaucoma (5%). Conclusion ART represents a valuable salvage technique for refractory full-thickness macular holes, achieving meaningful anatomical closure and visual improvement. Restoration of photoreceptor integrity (external limiting membrane and ellipsoid zone) correlated with visual recovery. Although technically demanding and associated with potential complications, ART offers a promising therapeutic avenue for otherwise untreatable cases. Larger multicenter studies with longer follow-up and standardized surgical protocols are warranted.