A NOVEL SURGICAL TECHNIQUE FOR GIANT AND REFRACTORY MACULAR HOLES: AUTOLOGOUS TENON CAPSULE PLUG

Abstract

Purpose: To evaluate the safety and efficiency of the autologous Tenon capsule plug (ATCP) technique for the treatment of large (1000 um<) and refractory macular holes (MHs). Methods: This retrospective, interventional, case series included 3 patients who underwent 23-gauge vitrectomy and ATCP technique for giant or refractory MH. All patients underwent a complete ophthalmic examination including optical coherence tomography (OCT), OCT angiography (OCTA), and microperimetry (MP). The changes in retinal structure and function were evaluated. Results: The minimum follow-up was 6 months. The preoperative minimum hole diameters were 728 um, 422 um, and 1154 um for case 1, case 2, and case 3 respectively. Case 1 and case 2 had an idiopathic MH that failed to close after vitrectomy with (internal limiting membrane) ILM peeling, whereas case 3, who had a giant, irregular MH underwent the ATCP technique as the primary intervention. Complete hole closure was achieved in all patients at the last follow-up. However, case 1 required a second ATCP surgery due to dislodgement of the plug in the early postoperative period. The BCVA increased in all patients. The final MP analysis revealed that the percentage of fixation points at circles 4o for case 1, case 2 and case 3 were 93.5%, 99.9% and 95.6% respectively. Conclusions: We suggest that the ATCP technique can provide a simple, cheap, repeatable, and readily available surgical solution for the treatment of giant and refractory macular holes. Further prospective studies with a larger sample size are needed to confirm our preliminary results.