目的:报告安全性,难治性大的未闭合黄斑裂孔患者自体神经感觉视网膜移植的解剖和功能结果。
方法:这是一个前瞻性病例系列,包括4名患有大型慢性黄斑裂孔的患者,他们接受了玻璃体切除术和硅油填塞的游离皮瓣神经感觉视网膜移植手术。用直径约为1.5-1.8mm的自体视网膜移植封闭孔,在血管拱廊外收获。使用最佳矫正视力(BCVA-Snellen)评估解剖和功能结果,光学相干断层扫描(OCT),OCT血管造影,显微视野(MP),多焦视网膜电图(mfERG)。
结果:有2名男性和2名女性患者,中位年龄为73(60-81)岁。中位随访期为17(13-23)个月。黄斑裂孔的术前中位数在最宽的基础直径为1872.5(868-2591)μm,在最小直径为828(556-1099)μm。在所有情况下,手术均导致黄斑孔的解剖闭合。OCT显示移植的结构整合和内段椭圆体的不同程度的再现。BCVA较术前0.1(6/60;+1.0logMAR)改善,0.1(6/60;+1.0logMAR),0.05(6/120;+1.3logMAR),病例1、2和4的术后为0.005(6/1200;+2.3logMAR)至0.2(6/30;+0.7logMAR),病例3的术后为0.1(6/60;+1.0logMAR)。术后所有患者的MP在与移植面积相对应的区域(直径为1.8mm的圆圈)显示视网膜功能(该区域的中位灵敏度为4.0dB,范围1.8-12.4dB)。在手术前进行MP的患者中注意到改善(平均灵敏度从0提高到1.8dB)。可检测的功能主要位于移植的周围区域。多灶性ERG4例中有3例表现为中央环功能异常,第二环功能正常。OCT血管造影显示灌注正常,没有新血管形成的迹象。没有术中或术后并发症。
结论:自体视网膜移植术是闭合大型难治性黄斑裂孔的成功技术。该程序是安全的,并提供良好的解剖结果。视敏度,显微视野,mfERG建议移植外部区域的一些逐渐的功能整合,但是到目前为止还没有发现中央功能恢复。
OBJECTIVE: To report the safety, anatomical and functional outcomes of autologous neurosensory retinal transplant in patients with a refractory large unclosed macular hole.
METHODS: This is a prospective case series of four patients with large chronic macular hole that underwent vitrectomy and free-flap neurosensory retinal transplantation surgery with silicone oil tamponade. The hole was closed with an autologous retinal transplant of an approximate diameter of 1.5-1.8 mm, harvested outside the vascular arcades. Anatomical and functional outcomes were assessed using best-corrected visual acuity (BCVA-Snellen), optical coherence tomography (OCT), OCT angiography, microperimetry (MP), and multifocal electroretinography (mfERG).
RESULTS: There were 2 male and 2 female patients with median age of 73 (60-81) years. The median follow-up period was 17 (13-23) months. The median preoperative size of the macular hole was 1872.5 (868-2591) μm at the widest basal diameter and 828 (556-1099) μm at the minimum diameter. Surgery resulted in the anatomical closure of the macular hole in all cases. The OCT showed structural integration of the transplant and reappearance of the inner segment ellipsoid to different extents. The BCVA improved from preoperative 0.1 (6/60; + 1.0 logMAR), 0.1 (6/60; + 1.0 logMAR), 0.05 (6/120; + 1.3 logMAR), and 0.005 (6/1200; + 2.3 logMAR) to 0.2 (6/30; + 0.7 logMAR) postoperatively in cases 1, 2, and 4, and to 0.1 (6/60; + 1.0 logMAR) in case 3. MP showed retinal function in the region corresponding to the area of the transplant (circle of 1.8 mm in diameter) in all patients after the surgery (median sensitivity in that region was 4.0 dB, range 1.8-12.4 dB). Improvement was noted in the patient that had MP performed before the surgery (mean sensitivity improved from 0 to 1.8 dB). Detectable function was mostly located in the peripheral regions of the transplant. Multifocal ERG showed abnormal function of the central ring and normal function of the second ring in 3 of 4 cases. The OCT angiography showed normal perfusion, without signs of neovascularization. There were no intra- or postoperative complications.
CONCLUSIONS: Autologous retinal transplantation surgery is a successful technique for closing of large refractory macular holes. The procedure is safe and provides good anatomical results. Visual acuity, microperimetry, and mfERG suggest some gradual functional integration of outer regions of the transplants, but no central functional restitution has been detected as yet.