Vascularization and Reperfusion of Autologous Retinal Transplant for Giant Macular Holes

Question  What happens to the blood supply for a large transplanted retina tissue?

Findings  In this study of 2 patients with giant macular holes who underwent autologous retinal transplant, vascularization and reperfusion of retinal graft was demonstrated by multimodal imaging within a few weeks of transplant.

Meaning  Vascular reperfusion of large autologous retinal grafts has implications for transplant survival.

Importance  Autologous retinal transplant is a recently described treatment modality for myopic and other refractory macular holes (MH). Establishment of blood supply may influence survival of a transplanted tissue. However, there are currently no reports on the vascular status of a transplanted retinal graft.

Objective  To report on vascularization and reperfusion of autologous retinal graft after transplant for giant MHs demonstrated by multimodal imaging.

Design, Setting, Participants  Two patients with giant MH (basal diameter ≥2000 μm) who underwent autologous retinal transplant at Retina-Vitreous Associates Medical Group in Los Angeles, California, in June 2018 and February 2019, respectively, were included.

Main Outcomes and Measures  Status of MH, Snellen visual acuity, optical coherence tomography, optical coherence tomography angiography, and fluorescein angiography findings.

Results  Two eyes of 2 female patients were included. The mean age was 68.5 years. Baseline visual acuity was counting fingers and 20/200, and MHs measured 3441 μm and 2387 μm, respectively. Six weeks postoperatively, MHs were closed and the superficial inner retina blood vessels within the graft appeared perfused. Optical coherence tomography and optical coherence tomography angiography demonstrated early integration of the graft into the surrounding retina and perfused graft vasculature in both patients. Fluorescein angiography confirmed perfusion of retinal graft. At the last follow-up, visual acuity was 20/200 and 20/150, respectively, the MH was closed, and the retinal grafts were perfused.

Conclusions and Relevance  Autologous neurosensory retinal transplant may be used for the treatment of giant MHs. Vascularization and reperfusion of the retinal graft is observed within 6 weeks of transplant. It is hypothesized that visual improvement occurs as a result of flattening of the MH rim, partial centripetal migration of MH edges during the early healing phase, and further centripetal migration in the later phase associated with the shrinkage of the retinal graft.