Abstract
Purpose To analyze the anatomical and functional outcomes after autologous lens capsule transplantation in patients with persistent macular hole. Methods This is a retrospective observational study of five eyes of five patients treated with vitrectomy and autologous lens capsular flap transplantation. Complete ophthalmic examination was performed preoperatively and seven days and 1, 3, 6, 12, and 18 months after surgery. Results Successful macular hole closure was achieved in all patients. The mean minimum macular hole diameter before the surgery was 666.8 µm, and the mean basal diameter was 1086.4 µm. The mean visual acuity before lens capsular flap transplantation was 20/200, while after surgery, it was 20/125. Conclusions Autologous lens capsular flap transplantation is a potential alternative treatment for patients with large persistent macular holes after other operative techniques have failed.
Highlights
Pars plana vitrectomy with internal limiting membrane (ILM) peeling has been a standard procedure in macular hole (MH) treatment for over a decade [1]
One modified technique involves transplanting material from the anterior or posterior lens capsule onto the MH [5, 7, 8] (Figures 1 and 2). is technique proved effective in persistent holes after extensive ILM peeling and is the main topic of this article
Transplantation of a flap harvested from the posterior lens capsule was performed in four pseudophakic patients, and phacovitrectomy was done in one patient, using material from the anterior lens capsule of the same eye to close the hole
Summary
Pars plana vitrectomy with internal limiting membrane (ILM) peeling has been a standard procedure in macular hole (MH) treatment for over a decade [1]. Operative failures might occur with large, persistent holes, exceeding 400 μm in diameter Such failures have encouraged surgeons to search for modifications to the conventional technique, often using autologous tissue as a scaffolding for cell migration from the surrounding retina, including inverted ILM flap, autologous ILM graft from the surrounding retina, autologous retina, autologous blood application, and lens capsule [4–10]. Transplantation of a flap harvested from the posterior lens capsule was performed in four pseudophakic patients, and phacovitrectomy was done in one patient, using material from the anterior lens capsule of the same eye to close the hole. A direct exchange of PFCL with 1000 Cs silicone oil was performed to ensure that the unattached posterior capsular flap was not lost. In the one case where an anterior capsular flap was employed, PFCL/air exchange was performed and the patient was informed about the necessity of maintaining a face-down position for three days after the surgery
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