Autologous retina transplantation for refractory highly myopic macular holes: a long-term follow-up

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Purpose</jats:title> <jats:p>To evaluate long-term anatomical and functional outcomes of autologous retinal transplantation (ART) in refractory highly myopic macular holes (HMMHs).</jats:p> </jats:sec> <jats:sec> <jats:title>Study design</jats:title> <jats:p>Retrospective interventional analysis of 9 eyes with refractory HMMH undergoing ART.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Best-corrected visual acuity (BCVA, Snellen) and optical coherence tomography (OCT) were performed at baseline and each follow-up visit (1, 3, 6, 12, 24 months and the most recent). Preoperatively, we collected minimum linear diameter (MLD) and basal diameter (BD). Post-operatively, central macular thickness (CMT), external limiting membrane (ELM)/ellipsoid zone (EZ) visibility, macular edema (ME) and retinal pigmented epithelium (RPE) atrophy were evaluated.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Mean follow-up duration was 46.0 ± 19.6 months. Anatomical success was reached in 7/9 eyes (78%). Median BCVA went from 0.05 (IQR 0.065) at baseline to 0.075 (IQR 0.069) at final follow-up (<jats:italic>p</jats:italic> = 0.25). Only one eye showed a 2-lines improvement, while BCVA was stable in 4/9 (44%) and worsened in 1 eye (12%). CMT progressively thickened in the first 6 months (177 ± 68 μm), but then decreased to 122 ± 50 μm at final follow-up. Graft merging with the surrounding retina was visible in two eyes, showing partial ELM/EZ recovery and good outcomes. Microcystic-like refractory ME (33%) and long-term RPE atrophy (22%) were reported, while delayed displacement of the graft was seen in one case 6 months after first surgery.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>ART offered acceptable anatomical success but no visual improvement in our cohort. Lack of graft merging with the surrounding retina, persistent microcystic-like ME, RPE atrophy and hole recurrence were the most frequent shortfalls.</jats:p> </jats:sec>