Autologous retinal graft surgery for refractory macular holes without postoperative head positioning.

Abstract

To evaluate the efficacy of autologous retinal graft (ARG) surgery using a novel technique of Viscoat as a graft adherent and stabilizer for large, refractory macular holes (MHs) without postoperative face-down positioning. This retrospective interventional case series included 13 patients with refractory MHs who underwent ARG surgery. The surgical technique involved retinal graft placement stabilized with Viscoat, without postoperative positioning. Preoperative, 6 months and 12 months postoperative outcomes, including MH closure rates and visual acuity (VA) were analyzed. Pre-op mean MH size was 821.69 ± 180.65 µm (range: 563-1200 µm). Anatomical closure was achieved in 76.9% (10/13) of cases. Median VA improved from 1.7 logMAR (20/1000) preoperatively to 1.3 logMAR (20/400) at 6 months and at 12 months postoperatively, although this change was not statistically significant (p = 0.106 and p = 0.311 respectively). No major complications were reported. Larger MH size and chronicity might limit functional improvement despite successful closure. This is the first study to demonstrate that ARG surgery with Viscoat can achieve high closure rates without postoperative head positioning. The technique offers a patient-friendly alternative for refractory MH management, reducing postoperative burden while maintaining promising anatomical outcomes. Further studies with larger cohorts are warranted to validate these findings.