Surgical Treatment of Refractory Medium Macular Hole with Autologous Lens Capsular Flap Transplantation: A Case Report.

Abstract

To report the clinical results of lens capsular flap (LCF) transplantation in a patient with refractory medium macular hole (MH). Case report. A 66-year-old female myopic patient with a history of medium macular hole (MH) was previously unsuccessfully treated by vitrectomy surgery, internal limiting membrane (ILM) peeling and air-fluid exchange followed by 12% C2F6 tamponade into the vitreous cavity and face-down positioning. After the first surgery, the patient's visual acuity of the left eye remained only 20/400 on the Snellen scale, and a persistent medium MH (290 µm) was observed on optical coherence tomography. Cataract of the left eye was also noted. A second surgery, combined cataract-vitrectomy surgery, was carried out to seal the MH, performed under retrobulbar anesthesia. Because there was insufficient ILM tissue to perform the ILM flap procedure, we decided to use another technique involving an autologous LCF. The patient underwent LCF placement onto the MH along with gas tamponade. At 6 months, the MH was sealed, and the patient's vision had improved to 20/32 on the Snellen scale. This is the first case report to describe the use of LCF to treat persistent medium MH. LCF seems to be effective in sealing small macular holes and was well tolerated by the patient.