Induced local retinal detachment with preservation of the internal limiting membrane as the least traumatic method of autologous neuroepithelium transplantation in large-diameter through macular holes

The autologous retina transplantation technique is the transplantation of the peripheral retina into the central zone after flap mobilization using either endothermocoagulation or an endolaser. Firstly, the thermal effect on the chorioretinal complex leads to its transformation into a single conglomerate, which complicates the graft’s «grip» and its separation from the choroidea. Secondly, the flap translocated into the macular zone already contains in its structure a section of tissue necrotized by a burn, which can have a toxic effect on both retinal and choroidal tissue exposed by the macular opening. The aim of our work was to study the most gentle method of autologous retinal trasplantation in large-diameter through macular ruptures, including induced peripheral local detachment, as the least traumatic way to mobilize the retinal flap and completely preserve the ILM in the rupture zone. Material and methods. 5 patients with a diagnosis of end-to-end macular were operated on, with a total of 6 eyes. The diameter of the hole is from 900 microns to 1740 microns. The technique of the operation. First, a standard 3-port vitrectomy of 25 gage was performed. With the help of an endocoagulator, four through retinal openings were performed. The next step was the hydrodissection of chorioretinal joints through the ruptures formed, achieving detachment of the future flap. Further mobilization was carried out with the help of «guillotine» scissors. The movement to the macular area was carried out under perfluorodecalin. On day 3, perfluorodecalin was changed to silicone oil, which was removed 1 month after surgery. Results and discussion. In all cases, it was possible to achieve complete closure of the macular opening. Visual acuity after removal of silicone oil remained at the same level in 1 patient, the rest increased to 0.1-0.2. Conclusion. Induced local retinal detachment with the preservation of ILM in the macular zone can be used as a less traumatic method of autologous retinal transplantation with through large-diameter macular holes. Keywords: transplantation, autologous retina, macular hole