Recalcitrant Macular Hole Closure by Autologous Retinal Transplant Using the Peripheral Retina

Keiko Yamada,1,2 Takatoshi Maeno,3 Shunji Kusaka,4 Jorge G Arroyo,2 Mitsunori Yamada5 1Department of Ophthalmology, Faculty of Medicine, Osaka University, Osaka, Japan; 2Department of Ophthalmology, Harvard University Beth Israel Deaconess Medical Center, Boston, MA, USA; 3Department of Ophthalmolog...

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Autores principales:	Yamada K, Maeno T, Kusaka S, Arroyo JG, Yamada M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	retina macula hole vitrectomy muller glia stem cell transplant Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/8ae23d3ee3b340bcbe76b6fa4cc1a365
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spelling	oai:doaj.org-article:8ae23d3ee3b340bcbe76b6fa4cc1a3652021-12-02T10:24:34ZRecalcitrant Macular Hole Closure by Autologous Retinal Transplant Using the Peripheral Retina1177-5483https://doaj.org/article/8ae23d3ee3b340bcbe76b6fa4cc1a3652020-08-01T00:00:00Zhttps://www.dovepress.com/recalcitrant-macular-hole-closure-by-autologous-retinal-transplant-usi-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Keiko Yamada,1,2 Takatoshi Maeno,3 Shunji Kusaka,4 Jorge G Arroyo,2 Mitsunori Yamada5 1Department of Ophthalmology, Faculty of Medicine, Osaka University, Osaka, Japan; 2Department of Ophthalmology, Harvard University Beth Israel Deaconess Medical Center, Boston, MA, USA; 3Department of Ophthalmology, Toho University Sakura Medical Center, Chiba, Japan; 4Department of Ophthalmology, Faculty of Medicine, Kindai University, Osaka, Japan; 5Yamada Eye Clinic, Tokushima, JapanCorrespondence: Keiko Yamada Email meyamada@mb3.tcn.ne.jpPurpose: The peripheral adult human retina has been found to contain neuroepithelial stem cells. In this study, we examined the efficacy of an auto-transplant of peripheral retina into refractory macular holes (MH) from both anatomic and physiologic perspectives.Methods: The population consisted of four female patients aged 72, 82, 65 and 84 years (cases 1– 4, respectively) with persistent refractory MH status; internal limiting membrane (ILM) peeling (case 1), ILM transplant (case 2), and inverted ILM (cases 3 and 4 with myopic MH). In all our cases, retinal grafts were harvested beyond the equator from the far retinal periphery using curved horizontal scissors and gently moved toward the MH using a forceps. A 25-G manipulator with a silicone ball tip was used to tuck the trimmed graft into the MH, followed by fluid-air exchange and infusion of silicone oil, which was removed three months later.Results: Partial restoration and integration of the outer retinal layer were confirmed on an OCT-B scan imaging. The visual acuity (VA) was improved in all cases: 1.2 to 1.0 logMAR (case 1), 2.0 to 1.3 logMAR (case 2), 2.3 to 1.4 logMAR (case 3) and 2.0 to 1.0 logMAR (case 4). Microperimetry showed improved retinal sensitivity in every case. No intra- or post-operative complications were observed.Conclusion: Under pathological conditions, the Müller glia reportedly serves as a source of neuronal progenitor cells in regenerating retina, continuing to divide and migrate to the outer nuclear layer thus replacing lost photo-receptors. Although the histological findings remain unknown, the positive anatomic and physiologic outcomes of the auto-transplanted retinal flap in our series suggest that this technique may offer an effective option for treating recalcitrant MH. Further studies are warranted.Keywords: retina, macular hole, vitrectomy, stem cell, transplant; Müller gliaYamada KMaeno TKusaka SArroyo JGYamada MDove Medical Pressarticleretinamacula holevitrectomymuller gliastem celltransplantOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 14, Pp 2301-2306 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	retina macula hole vitrectomy muller glia stem cell transplant Ophthalmology RE1-994
spellingShingle	retina macula hole vitrectomy muller glia stem cell transplant Ophthalmology RE1-994 Yamada K Maeno T Kusaka S Arroyo JG Yamada M Recalcitrant Macular Hole Closure by Autologous Retinal Transplant Using the Peripheral Retina
description	Keiko Yamada,1,2 Takatoshi Maeno,3 Shunji Kusaka,4 Jorge G Arroyo,2 Mitsunori Yamada5 1Department of Ophthalmology, Faculty of Medicine, Osaka University, Osaka, Japan; 2Department of Ophthalmology, Harvard University Beth Israel Deaconess Medical Center, Boston, MA, USA; 3Department of Ophthalmology, Toho University Sakura Medical Center, Chiba, Japan; 4Department of Ophthalmology, Faculty of Medicine, Kindai University, Osaka, Japan; 5Yamada Eye Clinic, Tokushima, JapanCorrespondence: Keiko Yamada Email meyamada@mb3.tcn.ne.jpPurpose: The peripheral adult human retina has been found to contain neuroepithelial stem cells. In this study, we examined the efficacy of an auto-transplant of peripheral retina into refractory macular holes (MH) from both anatomic and physiologic perspectives.Methods: The population consisted of four female patients aged 72, 82, 65 and 84 years (cases 1– 4, respectively) with persistent refractory MH status; internal limiting membrane (ILM) peeling (case 1), ILM transplant (case 2), and inverted ILM (cases 3 and 4 with myopic MH). In all our cases, retinal grafts were harvested beyond the equator from the far retinal periphery using curved horizontal scissors and gently moved toward the MH using a forceps. A 25-G manipulator with a silicone ball tip was used to tuck the trimmed graft into the MH, followed by fluid-air exchange and infusion of silicone oil, which was removed three months later.Results: Partial restoration and integration of the outer retinal layer were confirmed on an OCT-B scan imaging. The visual acuity (VA) was improved in all cases: 1.2 to 1.0 logMAR (case 1), 2.0 to 1.3 logMAR (case 2), 2.3 to 1.4 logMAR (case 3) and 2.0 to 1.0 logMAR (case 4). Microperimetry showed improved retinal sensitivity in every case. No intra- or post-operative complications were observed.Conclusion: Under pathological conditions, the Müller glia reportedly serves as a source of neuronal progenitor cells in regenerating retina, continuing to divide and migrate to the outer nuclear layer thus replacing lost photo-receptors. Although the histological findings remain unknown, the positive anatomic and physiologic outcomes of the auto-transplanted retinal flap in our series suggest that this technique may offer an effective option for treating recalcitrant MH. Further studies are warranted.Keywords: retina, macular hole, vitrectomy, stem cell, transplant; Müller glia
format	article
author	Yamada K Maeno T Kusaka S Arroyo JG Yamada M
author_facet	Yamada K Maeno T Kusaka S Arroyo JG Yamada M
author_sort	Yamada K
title	Recalcitrant Macular Hole Closure by Autologous Retinal Transplant Using the Peripheral Retina
title_short	Recalcitrant Macular Hole Closure by Autologous Retinal Transplant Using the Peripheral Retina
title_full	Recalcitrant Macular Hole Closure by Autologous Retinal Transplant Using the Peripheral Retina
title_fullStr	Recalcitrant Macular Hole Closure by Autologous Retinal Transplant Using the Peripheral Retina
title_full_unstemmed	Recalcitrant Macular Hole Closure by Autologous Retinal Transplant Using the Peripheral Retina
title_sort	recalcitrant macular hole closure by autologous retinal transplant using the peripheral retina
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/8ae23d3ee3b340bcbe76b6fa4cc1a365
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Recalcitrant Macular Hole Closure by Autologous Retinal Transplant Using the Peripheral Retina

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