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Background <p>This study investigates the efficacy and feasibility of a novel surgical technique combining corneal stromal lenticule (CSL) covering with intraocular tamponade for treating recurrent macular holes (MHs) and macular hole retinal detachments (MHRDs).</p> Methods <p>This prospective, non-randomized case series included 15 patients (15 eyes) with a mean age of 54.13 ± 11.22 years who were enrolled at Mianyang Wanjiang Eye Hospital from January 2021 to December 2023. All patients had previously undergone vitrectomy and internal limiting membrane (ILM) peeling. During the reoperation procedure, residual peripheral vitreous was meticulously removed when visualized with triamcinolone acetonide (TA). Similarly, expanded ILM peeling was performed in areas showing positive indocyanine green staining. Autologous platelet concentrates and CSL were applied to cover the macular area, followed by C3F8 gas or Silicone Oil (SO) tamponade. Patients with combined cataracts affecting fundus surgery underwent phacoemulsification and intraocular lens implantation. Postoperatively, patients maintained a face-down or lateral position, and SO was removed when MH closure and retinal reattachment were confirmed. Six months after complete gas absorption or SO removal, Best Corrected Visual Acuity (BCVA), MH closure, retinal reattachment rate, Axial Length (AL), Intraocular Pressure (IOP), Foveal Avascular Zone (FAZ), Superficial Vascular Density (SVD), reoperation rate, and surgical complications were analyzed.</p> Results <p>At the end of follow-up, all patients achieved anatomical retinal reattachment (100%) and MH closure (100%) as evaluated by Optical Coherence Tomography (OCT). No reoperations were required. Mean BCVA(logMAR) improved from 1.95 ± 0.27 preoperatively to 1.33 ± 0.21 postoperatively (<i>P</i> &lt; 0.05), representing a statistically significant improvement. No significant difference in AL occurred before and after surgery, but a significant difference was observed in IOP. During follow-up, FAZ decreased and SVD increased. The CSLs remained well-positioned in all cases without displacement. No MH reopening or retinal redetachment occurred, and no severe complications were observed during surgery or follow-up.</p> Conclusion <p>CSL covering technique combined with intraocular tamponade shows promise as a treatment for recurrent MHs and MHRDs in this preliminary case series. The technique had good surgical success rate, no cases needed reoperation, and patients’ visual function improved in this series. However, this study is limited by its small sample size and relatively short follow-up period. Larger sample sizes and longer follow-up periods are needed to further validate the long-term efficacy and safety of this technique.</p>

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Corneal stromal lenticule covering technique combined with intraocular tamponade for the treatment of recurrent macular holes and macular hole retinal detachments

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  • 发表日期：

    2025年12月6日

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  • Xiaojuan Zhang,
  • Gang Qiao,
  • Yukun He,
  • Hui Jiang,
  • Yan Liu,
  • Ziyan Tang

摘要

Background

This study investigates the efficacy and feasibility of a novel surgical technique combining corneal stromal lenticule (CSL) covering with intraocular tamponade for treating recurrent macular holes (MHs) and macular hole retinal detachments (MHRDs).

Methods

This prospective, non-randomized case series included 15 patients (15 eyes) with a mean age of 54.13 ± 11.22 years who were enrolled at Mianyang Wanjiang Eye Hospital from January 2021 to December 2023. All patients had previously undergone vitrectomy and internal limiting membrane (ILM) peeling. During the reoperation procedure, residual peripheral vitreous was meticulously removed when visualized with triamcinolone acetonide (TA). Similarly, expanded ILM peeling was performed in areas showing positive indocyanine green staining. Autologous platelet concentrates and CSL were applied to cover the macular area, followed by C3F8 gas or Silicone Oil (SO) tamponade. Patients with combined cataracts affecting fundus surgery underwent phacoemulsification and intraocular lens implantation. Postoperatively, patients maintained a face-down or lateral position, and SO was removed when MH closure and retinal reattachment were confirmed. Six months after complete gas absorption or SO removal, Best Corrected Visual Acuity (BCVA), MH closure, retinal reattachment rate, Axial Length (AL), Intraocular Pressure (IOP), Foveal Avascular Zone (FAZ), Superficial Vascular Density (SVD), reoperation rate, and surgical complications were analyzed.

Results

At the end of follow-up, all patients achieved anatomical retinal reattachment (100%) and MH closure (100%) as evaluated by Optical Coherence Tomography (OCT). No reoperations were required. Mean BCVA(logMAR) improved from 1.95 ± 0.27 preoperatively to 1.33 ± 0.21 postoperatively (P < 0.05), representing a statistically significant improvement. No significant difference in AL occurred before and after surgery, but a significant difference was observed in IOP. During follow-up, FAZ decreased and SVD increased. The CSLs remained well-positioned in all cases without displacement. No MH reopening or retinal redetachment occurred, and no severe complications were observed during surgery or follow-up.

Conclusion

CSL covering technique combined with intraocular tamponade shows promise as a treatment for recurrent MHs and MHRDs in this preliminary case series. The technique had good surgical success rate, no cases needed reoperation, and patients’ visual function improved in this series. However, this study is limited by its small sample size and relatively short follow-up period. Larger sample sizes and longer follow-up periods are needed to further validate the long-term efficacy and safety of this technique.