Autologous Transplantation of Internal Limiting Membrane for the Treatment of Large Macular Hole

Kyong Ho Kim; Jae Woo Jung; Sung Who Park; Ik Soo Byon; Ji Eun Lee

doi:10.3341/jkos.2015.56.12.1899

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Kim, Jung, Park, Byon, and Lee: Autologous Transplantation of Internal Limiting Membrane for the Treatment of Large Macular Hole

Original Article

J Korean Ophthalmol Soc 2015;56(12):1899-1905.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.12.1899

Autologous Transplantation of Internal Limiting Membrane for the Treatment of Large Macular Hole

Kyong Ho Kim, M.D^1,², Jae Woo Jung, M.D¹, Sung Who Park, M.D³, Ik Soo Byon, M.D^1,^2,^4,, Ji Eun Lee, M.D, PhD^3,⁴

¹Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea

²Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

³Department of Ophthalmology, Pusan National University Hospital ^³, Busan, Korea

⁴Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea

Address reprint requests to Ik Soo Byon, MD Department of Ophthalmology, Pusan National University Yangsan Hospital, #20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: 82-55-360-2592, Fax: 82-55-360-2161 E-mail: isbyon@naver.com

‗ This study was supported by a 2015 research grant from Pusan National University Yangsan Hospital.

Received 22 May 20155 August 2015 Accepted 25 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the surgical outcome of autologous transplantation of internal limiting membrane (ILM) for the treatment of large macular hole.

Methods

Twenty-five gauge pars plana vitrectomy was performed for the treatment of patients with full thickness macular hole larger than 400 μ m. ILM was stained using 0.025% brilliant blue G. ILM around the hole was circumferentially peeled as large as 2.5 disc diameter (DD) in size and then transplanted inside the hole. ILM was peeled out additionally approximately 1.5 DD in size. Fluid-air exchange and gas injection were performed. After surgery, the hole was scanned using spectral domain optical coherence tomography.

Results

A total of 5 eyes were included in the present study. The mean age was 65.0 ± 11.8 years (52-77) and mean best cor-rected visual acuity (log MAR) was 0.80 ± 0.27. The mean refractive error was -2.0 ± 2.2 diopter, mean horizontal size of hole was 701.4 ± 129.4 μ m, mean vertical size was 630.2 ± 202.8 μ m, mean hole base size was 1,043.4 ± 225.0 μ m and hole height was 464.4 ± 218.9 μ m. At the first day after surgery, transplanted ILM was detected inside the hole in all 5 eyes and complete closure of the hole occurred in 4 eyes. One hole was closed between postoperative days 4 and 7. Foveal contour improved gradually but photoreceptor integrity did not during the follow-up period. Two eyes showed visual improvement but 3 did not after surgery.

Conclusions

Macular hole was closed successfully and quickly using the autologous ILM transplantation technique. Based on our results, the autologous ILM should be considered the treatment of choice for large macular holes.

Keywords: Autologous internal limiting membrane implantation, Macular hole

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Figure 1.

Fundus image during the autologous transplantation of the internal limiting membrane (ILM). ILM stained by 0.025% Brilliant Blue G dye was placed in the macula hole (white arrow).

Figure 2.

A case of full thickness macular hole (MH) in 52-year-old female. Preoperative color fundus photograph (A) and OCT (B, horizontal white line: 1 mm scale bar) of the right eye demonstrated diabetic retinopathy and large macular hole. One day after sur-gery, transplanted internal limiting membrane was seen inside hole (white arrow), MH was closed (C). At 3 months, type 1 closure of hole was detected in OCT scan image. Snellen vision improved from 0.1 to 0.4 (D). OCT = optical coherence tomography.

Figure 3.

A case of closure of a macular hole (MH) in 54-year-old female. Preoperative color fundus photograph (A) and optical co-herence tomography (OCT) (B, horizontal white line: 1 mm scale bar) shows the full thickness MH with perifoveal cyst. One day after surgery, the MH had closed and transplanted inner limiting membrane is seen inside the hole (white arrow) (C). At 1 month, OCT scan shows type 1 closure MH (D).

Figure 4.

A case in 76-year-old male. Preoperative color fundus photograph (A) and optical coherence tomography (OCT) (B, hori-zontal white line: 1 mm scale bar) showing the multiple soft drusen and the large macular hole. At 6 months, OCT scan image showed the improvement of foveal configuration (type 1 closure of hole), but photoreceptor layer remained disrupted (C). His snell-en vision slightly improved from 0.1 to 0.15.

Table 1.

Characteristics of patients

Case number	^Sex	Age (years)	Laterality	Refractive error (diopter)	Axial length (mm)	Hole size (horizontal/vertical, μ m)	Hole height (μ m)	Hole base (μ m)	e Other ocular disorder
1	F	52	OD	-1.0	22.66	830/830	320	1,328	DR
2	F	54	OD	-5.0	26.61	725/637	845	1,172	Retinal tear, pseudophakia
3	M	77	OD	-3.75	23.75	711/441	382	759	Cataract
4	M	66	OS	0	23.04	485/411	448	890	Cataract
5	M	76	OD	-0.25	23.35	756/832	327	1,068	Dry AMD, cataract

F= female; M = male; OD = oculus dexter; OS = oculus sinister; DR = diabetic retinopathy; AMD = age-related macular degeneration.

Table 2.

Results of autologous internal limiting membrane transplantation

Case number	Time from symptom onset to surgery (days)	POD (months)	Baseline visual acuity (Snellen)	Postopertive visual acuity (Snellen)	Time to close hole after surgery (days)	Type of closure	IS/OS integrity
1	26	4	0.1	0.4	1	Type I	Disrupted
2	120	2	0.1	0.1	1	Type I	Disrupted
3	270	6	0.3	0.3	1	Type I	Disrupted
4	23	3	0.3	0.3	1	Type I	Disrupted
5	180	6	0.1	0.15	4-7	Type I	Disrupted

POD = postoperative day; IS/OS = inner segment/outer segment junction of the photoreceptor layer.

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