Autologous Retinal Transplant for Macular Holes

Macular holes are an anatomical defect that can result from the antero-posterior and tangential tractional forces that act on the fovea, ultimately causing it to dehisce from the underlying retinal pigment epithelium and causing a full-thickness retinal break between the two edges of the fovea. Idiopathic macular holes result from endogenic tractional forces acting on the retina. Secondary causes of macular holes include high myopia, trauma, macular schisis, and age-related macular degeneration. It can also result from sun or eclipse gazing, laser pointer use, and from anterior segment laser procedures. Macular hole surgery is a rapidly evolving branch of retinal surgery that has benefited from recent innovations in diagnostic imaging and surgical tools. Pars plana vitrectomy (PPV) alone improves the hole closure rate to 58% compared to natural history by removing anteroposterior vitreous traction from the fovea. Addition of the internal limiting membrane (ILM) peel improves success rate to over 90%. Certain features are associated with higher risk of surgical failure despite PPV with ILM peel and require nuanced approaches. These include using an inverted ILM Flap, a retracting door flap, or using Autologous Retinal Transplants.