Refractory Full Thickness Macular Hole

A patient presented with a “black central spot” in the right eye. The past ocular history included an idiopathic full thickness macular hole in the right eye that had undergone pars plana vitrectomy with internal limiting membrane peel two times. The left eye had neovascular glaucoma likely secondary to a vascular occlusion or proliferative diabetic retinopathy. Examination disclosed Snellen visual acuity of 20/150 in the right eye and longstanding hand motion vision in the left eye. Intraocular pressure was 15 mmHg and 17 mmHg. Slit lamp examination revealed an unremarkable anterior segment with posterior chamber intraocular lenses in both eyes. The posterior examination was notable for a circular defect in the macula with a reddish central hue in the right eye. Optical coherence tomography (OCT) of the right eye demonstrated a persistent full thickness macular hole with no vitreomacular traction. The patient underwent autologous retinal transplant for refractory full thickness macular hole. The graft was found to be dislocated inferiorly on post-operative day one examination with a persistent macular hole. The patient underwent a second transplant. Post-operative examinations demonstrated the graft in proper position with anatomic closure of the hole. Post -operative day one OCT displayed the graft as a hyperreflective tissue on the surface of the retina overlying and closing the hole. Follow up OCT displayed continued closure of the hole and apparent integration of the graft tissue. Snellen visual acuity at last examination was 20/50.

Presentation Date: 09/16/2021

Issue Date: 10/08/2021