Page 101 - A Magyar Szemorvostársaság 2023. évi kongresszusa - Tudományos program és előadáskivonatok

Case report: Our 77-year-old female patient had an ophthalmologic history of a carcinoma
planocellulare removal from the skin of the right outer eyelid. On 28 Sept 2022 on her left
amblyopic eye (previously best corrected visual acuity (BCVA): 0.65) with BCVA: 0.06, we
performed combined phacoemulsification with toric intraocular lens implantation (Precizon
Toric +22,5 D Cyl 1,0) and 23G PPV with ERM/ILM peeling and SF6 gas tamponade due to
cataract and stage 4 full thickness macular hole (IVMTS classification: large FTMH without
VMT; base diameter: 1365 μm, aperture size: 609 μm) and epiretinal membrane. At the first
post-operative follow-up (17 Oct 2022), the patient reported that she had not maintained the
requested head positioning at home and we found that the hole remained open (BCVA: 0.04;
base: 1137 μm, aperture size: 669 μm), so on 14 Dec 2022, we performed an autolog
neurosensory retinal transplantation using an ARTEVO 800 surgical microscope (Carl Zeiss
Meditec AG, Jena, Germany), during which intraoperative OCT confirmed the correct position
of the graft. At the end of the surgery, decalin (Arcad Ophta, Arcaline C10F18) was left in the
eye to help keep the graft in place, and the patient spent 5 days in a continuous supine position.
In the postoperative period, we noted a slight choroidal ablation and vitreous hemorrhage.
After five days, another surgery was performed to remove the decalin and vitreous
hemorrhage, followed by C3F8 insufflation. Eight weeks after surgery, a closed macular hole
was documented with 0.2 BCVA.

Conclusion: Autologous retinal transplantation to achieve closure of refractory macular holes
may be worth for consideration, on the other hand further experience is needed to define the
exact indication.