Abstract
PURPOSE: To investigate the outcome of primary idiopathic extra-large full-thickness macular holes (FTMH) treated with a modified autologous neurosensory retinal transplantation (ART) adjuncted by bevacizumab (BCZ) injection. METHODS: In this retrospective interventional case series, five consecutive patients with primary extra-large chronic FTMHs were investigated. The ART procedure included internal limiting membrane (ILM) peeling of both donor and macular hole (MH) areas, placement of the harvested tissue under the edges of MH and use of silicone oil tamponade. RESULTS: The median age was 64 (60-77) years. The first patient developed choroidal neovascularization one month after surgery, which was treated with BCZ injections. Subsequent patients received injection of BCZ (1.25 mg/0.05 mL) into the silicone oil at the end of the initial surgery. At the last follow-up, complete anatomical closure of the MH was achieved in all patients. With the exception of the first patient, all other patients achieved either a final ellipsoid zone (EZ) defect of zero (three cases) or a reduction to 100 μm (one case). The external limiting membrane (ELM) was completely reconstructed in all of patients. All patients demonstrated an improvement in best corrected distant visual acuity (BCDVA) one month after ART surgery, which was sustained throughout the follow-up period (12-42 months). The median LogMAR BCDVA at baseline was 1.4 (1.3-1.4) which decreased to 1.1(1.0-1.1) (P = 0.041) at the first month and 1.0 (0.7-1.2) (P = 0.043) at the last follow-up. CONCLUSIONS: The use of ART surgery accompanied by BCZ injection appears to be an effective method for primary extra-large chronic FTMHs.