Surgical management of refractory full-thickness macular holes with emphasis on autologous retinal transplantation: A narrative review

Full-thickness macular holes are central defects in the neurosensory retina that result in significant visual impairment, including reduced visual acuity and central scotomas. While most cases respond well to pars plana vitrectomy combined with internal limiting membrane peeling, a subset of macular holes remains refractory to standard interventions and presents a persistent surgical challenge. Among emerging techniques, autologous neurosensory retinal transplantation has shown considerable promise, particularly in chronic or large-diameter holes where the internal limiting membrane is no longer available for use. This review offers a comprehensive overview of full-thickness macular hole pathophysiology and classification, current surgical approaches for refractory cases, and the accumulating clinical evidence supporting autologous neurosensory retinal transplantation. By conducting a narrative review of peer-reviewed studies in PubMed, anatomical and functional outcomes, procedural advantages, and associated limitations are critically examined. Additionally, recent preclinical developments, such as stem cell-derived retinal grafts, are discussed as potential future directions. Autologous neurosensory retinal transplantation represents a significant advancement in the management of refractory macular holes, while cell-based therapies may hold transformative potential for regenerative retinal surgery.