Relaxing retinectomy and autologous retinal transplant for complex retinal detachment with macular hole: a case series

To describe the surgical techniques for transplantation of an autologous retinal graft in cases of chronic retinal detachment with proliferative vitreoretinopathy and full-thickness macular hole. Descriptive case series of three consecutive patients (1 woman and 2 men; ages 60, 60, and 61) who underwent pars plana vitrectomy with peeling of proliferative vitreoretinopathy membranes, followed by relaxing retinectomy, where a notch was created to harvest a full-thickness neurosensory retinal graft. Perfluoro-n-octane was injected to flatten the retinectomy edges and stabilize the graft, which was then separated from the retinectomy edge and gently mobilized under Perfluoro-n-octane using a finesse loop to plug the macular hole. Endolaser was applied to the retinectomy edge under Perfluoro-n-octane, followed by a controlled Perfluoro-n-octane –air exchange and silicone oil (5000 cSt) infusion. Primary outcomes were anatomical macular hole closure and retinal reattachment; visual outcomes were assessed by postoperative visual acuity, exam and imaging. Initial visual acuity ranged from light perception to hand motion. Postoperatively, visual acuity improved from light perception and hand motion to 20/400 and 20/200; the retina remained attached, and the macular hole was successfully closed, with the autologous retinal transplant integrating into the surrounding retinal tissue. Autologous retinal transplant, coupled with a relaxing retinectomy, may present a promising strategy for closing macular holes and improving visual acuity in cases of complex retinal detachment with proliferative vitreoretinopathy. We show that this procedure can be performed unimanually, potentially reducing technical demands in such cases.