Autologous Retinal Transplant Repeat Surgery after Initial Graft Failure: A Case Report

Abstract

Autologous retinal transplant (ART) has become an increasingly explored surgical option for managing large chronic holes refractory to standard surgical treatments. However, management strategies for patients who already failed a previous ART are less well-understood. Here, we report on a case of a successful repeat retinal transplant for a refractory macular hole after a previously dislocated ART graft. Subretinal injection of balanced salt solution was used to partially elevate the macular hole and secure the edge of the harvested retinal graft under the edge of the macular hole in the second operation. Postoperatively, the patient developed intraretinal fluid within the retinal graft with an appearance similar to cystoid macular edema, which was controlled with topical steroids. In addition, two separate choroidal neovascular membranes along the subretinal injection sites were seen and treated with vascular endothelial growth factor downregulation. This case illustrates successful repeat ART surgery, but further optimization of ART surgical techniques is necessary to minimize ART's complication rate.

Keywords: Autologous retinal transplant; Graft dislocation; Refractory macular hole.

Fig. 1.

Optical coherence tomography (OCT) of the macular hole (a) and color fundus photo of the fundus prior to both ART procedures (b).

Fig. 2.

Color fundus photo after first ART surgery with graft initially within the macular hole with superior gas (a). Color fundus photo at postoperative week three showing graft now dislodged from the macular hole (b). OCT showing dislodged graft (c).

Fig. 3.

Color fundus photo at postoperative month four showing the graft within macular hole (green arrow) and adjacent two areas of CNVM (red arrows) (a). OCT at postoperative month four showing graft integration to the host tissue with slight graft “slippage” nasally (b). OCT angiography of the avascular layers at postoperative month three showing two areas of choroidal neovascular membranes near the macular hole (c). Color fundus photo at postoperative month 18 (d). OCT showing graft integration and “CME-like” inner retinal edema (e). CME, cystoid macular edema.