Autologous retinal transplantation in cases of refractory and primary large macular holes: predictive biomarkers of graft integration, long-term results and personalization of the method

One of the new promising methods of surgical treatment of large macular holes (MH) is autologous retinal transplantation (ART) procedure. Purpose — рersonification of the ART. Material and methods. The first ART in the Russian Federation was carried out by me in March 02, 2021. The study included 35 patients (35 eyes) with diagnosed refractory (previously repeatedly operated without achieving closure of the hole) and large MH with a diameter of more than 800 microns. All patients conducted a standard tripport 25G vitrectomy. Then, a fragment of neurosettes from the peripheral zone was cut. The resulting transplant was transferred to the hole zone, then the PFCL was replaced by silicone or fixed by the gas mixture (C3F8). As a predictive criteria for assessing the integration and viability of the graft after the ART, control points (7 days and 1 month after the surgery) were determined and the following biomarkers were established: reconstruction of the ellipsoid zone, alignment of neurosenerable layers, the speed of vertical and horizontal integration of transplants. Results. 12 months after the operation, 98 % of patients had a complete anatomical closure of the MH. All patients were tracked at least 6 months after surgical treatment. Average value of best corrected visual acuity (BCVA) before surgery was 0.08, 6 months after surgery — 0.23. Two years after the ART, 20 patients were monitored, of which 15 (75 %) patients retained a high BCVA of 0.30 ± 0.08. Conclusion. The obtained high anatomical and functional results can be explained by the personification of ART for MH surgery: the method is overlapped for traumatic and refractory MH, and the edge in the edge for large primary MH.