Autologous retinal transplant harvest site long-term healing: Unexpected result

Abel Ramirez-Estudillo; Sergio E Hernández-Da Mota; Raul Velez-Montoya

doi:10.4103/ijo.IJO_2353_21

PHOTO ESSAY

Year : 2022 | Volume : 2 | Issue : 2 | Page : 597-598

Autologous retinal transplant harvest site long-term healing: Unexpected result

Abel Ramirez-Estudillo¹, Sergio E Hernández-Da Mota², Raul Velez-Montoya³
¹ Department of Retina, Hospital de Nuestra Señora de La Luz, Mexico City, México
² Department of Retina, Clínica David, Unidad Oftalmológica y Facultad de Medicina, Universidad Michoacana de San Nicolás de Hidalgo, García de León 598-2, Colonia Nueva Chapultepec, CP 58280, Morelia, Michoacán, México
³ Department of Retina, Asociación para Evitar le Ceguera en México IAP, México City, México

Date of Submission	08-Sep-2021
Date of Acceptance	03-Nov-2021
Date of Web Publication	13-Apr-2022

Correspondence Address:
Raul Velez-Montoya
Vicente García Torres #46. Col: San Lucas Coyoacán, México City - DF 04030
México

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_2353_21

Abstract

Keywords: Harvest site, healing process, long-term, macular hole, retinal transplant

How to cite this article:
Ramirez-Estudillo A, Hernández-Da Mota SE, Velez-Montoya R. Autologous retinal transplant harvest site long-term healing: Unexpected result. Indian J Ophthalmol Case Rep 2022;2:597-8

How to cite this URL:
Ramirez-Estudillo A, Hernández-Da Mota SE, Velez-Montoya R. Autologous retinal transplant harvest site long-term healing: Unexpected result. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 May 24];2:597-8. Available from: https://www.ijoreports.in/text.asp?2022/2/2/597/342948

Full-thickness autologous retinal transplantation (ART) is a surgical technique that has gained recognition for its ability to treat large macular holes previously considered untreatable.^[1] Since its introduction in 2016, several studies have been published regarding its functional and anatomic outcomes.^[1],[2],[3]

However, despite the low rate of surgical and postoperative complications and encouraging visual outcomes, retinal specialists still have logical concerns that prevent its widespread adoption. The main concern is the possibility of an increased risk of retinal detachment (RD) and proliferative vitreoretinopathy (PVR). Such concerns rely on the fact that little is known about the anatomical changes and healing processes that occur after a graft is taken from the retinal harvest site.

[Figure 1],[Figure 2],[Figure 3],[Figure 4] show a 66-year-old female patient with a history of 2 years of decreased visual acuity due to an extremely large macular hole (with baseline measurements of 1224 μm at its base and 476 μm in height) who was treated with ART. The best-corrected visual acuity (BCVA) before the surgery was 20/800. [Figure 1] shows the color fundus image taken during immediate postoperative care, which shows a donor graft slightly larger than the macular hole. [Figure 2],[Figure 3],[Figure 4] show OCT images of the harvest site 16 weeks after the surgery. The images are remarkable because they show that the retinal defect on the harvest site closed completely, with the migration of the ONL over the RPE, partial reconstitution on the inner retinal layers, realignment of outer layers, and a retinal defect completely cover with scar and gliosis tissue. The BCVA at week 16 of follow-up was 20/80 [Figure 5] and [Figure 6].

Figure 1: Color fundus image of a left eye. The harvest site is located in the mid-periphery of the superotemporal quadrant of the healthy retina, just above the superotemporal vascular arcades. The image shows a macular defect perfectly filled by a full-thickness retinal graft. The small white arrowheads show the borders of the bare RPE in the harvest site

Click here to view

Figure 2: OCT and infrared image of the superior aspect of the retina harvest site. The small white arrowheads show the ONL and ELM defects on the temporal border. The white arrows show the migration of the ONL over the RPE in the nasal border, along with the partial reconstitution of the inner nuclear layer. The small red arrowheads show gliosis and scar tissue and an epiretinal membrane

Click here to view

Figure 3: OCT and infrared image of the center of the retina harvest site. The small white arrowheads show the formation of a pseudofovea. The neuroretina is pulled toward the RPE layer, closing the gap with scar and gliosis tissue. There was no physical connection between the vitreous cavity and the subretinal space

Click here to view

Figure 4: OCT and infrared image of the inferior border of the retina harvest site. There is a thick layer of retinal gliosis overlying the partially reconstituted neuroretina with a thick epiretinal membrane (small white arrowheads)

Click here to view

Figure 5: Ultra-wide field fundus color image shows the healing process of the harvest site at week 16 of follow-up. The image shows a closed macular hole with a harvest site seemingly completely covered with retinal vessels bordering the original defect, but without crossing it completely

Click here to view

Figure 6: Ultra-wide field fundus red-free image shows the original border of the retinal defect on the harvest site and the encircling laser burns. The image also shows second- and third-order retinal vessels over the harvest site

Click here to view

Discussion

The retinal healing process is a complex phenomenon that is not yet fully understood. The evidence presented herein suggests that even after a large retinal defect is created, a healthy retina has the flexibility and capability to bridge extremely large gaps. Therefore, the risk of RD or PVR might be lower than previously suspected.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Grewal DS, Charles S, Parolini B, Kadonosono K, Mahmoud TH. Autologous retinal transplant for refractory macular holes: Multicenter international collaborative study group. Ophthalmology 2019;126:1399-408.
2.	Rojas-Juarez S, Cisneros-Cortes J, Ramirez-Estudillo A, Velez-Montoya R. Autologous full-thickness retinal transplant for refractory large macular holes. Int J Retina Vitreous 2020;6:60.
3.	Moysidis SN, Koulisis N, Adrean SD, Charles S, Chetty N, Chhablani JK, et al. Autologous retinal transplantation for primary and refractory macular holes and macular hole retinal detachments: The global consortium. Ophthalmology 2021;128:672-85.