[Autologous retinal transplantation in the surgery of large full-thickness macular holes].

Abstract

This review addresses the problem of treating large-diameter full-thickness macular holes (FTMH). Surgical repair of FTMHs has been successfully performed since the late 20^th century, however FTMHs with a diameter exceeding 500-600 µm, as well as cases combining FTMH with high myopia, rhegmatogenous retinal detachment (RRD), and refractory FTMHs, remain among the most challenging conditions for vitreoretinal surgeons. The widely used Gass and IVTS (International Vitreomacular Traction Study group) classifications do not adequately reflect the complexity of managing large-diameter FTMHs, in which the effectiveness of standard transconjunctival vitrectomy with membrane peeling and gas tamponade is significantly reduced. At the same time, numerous variations of surgical techniques with high rates of anatomical success have been developed for such defects. The article provides a brief overview of treatment methods for FTMHs that are most effective across different hole diameters, including giant holes (>1000 µm). A substantial portion of the review is devoted to the technique of autologous neurosensory retinal transplantation (ART), which has gained increasing popularity in recent years both internationally and in Russia. Its distinctive feature is the absence of a negative correlation between surgical effectiveness and hole diameter, which is characteristic of most existing techniques. The review discusses indications, surgical variations, potential complications and their management, along with known prognostic biomarkers of favorable functional outcomes and hypotheses regarding the mechanisms of visual function recovery following ART.