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Intra- and Postoperative Monitoring of Autologous Neurosensory Retinal Flap Transplantation for Refractory Macular Hole Associated with High Myopia.

PURPOSE
To describe the intra- and postoperative morphological and functional outcomes after autologous neurosensory retinal flap transplantation (ART) for high myopia-related refractory macular hole (MH).


METHODS
This prospective interventional study enrolled 5 eyes of 5 patients (age range 54-84 years) with highly myopic refractory MH who underwent ART. All cases were evaluated with intraoperative optical coherence tomography (OCT) and postoperative OCT, OCT angiography, and microperimetry for at least 6 months postoperatively.


RESULTS
Intraoperatively, the MH was covered by an ART flap with a persistent small subretinal space that was filled with the ART flap after 4-6 days. OCT discriminated the original from the transplanted retina. The mean basal diameter of the original MH decreased from 1504 ± 684 μm preoperatively to 1111 ± 356 μm postoperatively. The best-corrected visual acuity improved in 2 cases, was stable in 2 cases, and deterioration in 1 case. Microperimetry demonstrated no obvious postoperative changes in the fixation points and the absolute scotoma corresponding to the base of MHs with chorioretinal atrophy. In 2 eyes, choroidal neovascularization (CNV) developed beneath the transplanted retinas.


CONCLUSION
Transplanted tissue was in a fixed position by 1 week postoperatively with a decreased diameter of the original MH. Postoperative fixation points were on the original retina at the MH edge. Since CNV may develop, detailed monitoring is required.