title: Internal limiting membrane transplantation for unclosed and large macular holes.
abstract: BACKGROUND
  To present the surgical technique and clinical outcomes of transplantation of autologous internal limiting membrane (ILM) for large macular holes (MHs) after failed surgeries with ILM removal.
  
  
  METHODS
  Thirteen eyes of 13 consecutive patients with MHs larger than 500 μm after failed surgeries with ILM removal underwent vitrectomy with transplantation of autologous ILM. In the ILM transplantation technique, a small piece of the ILM was peeled off and transplanted inside the macular hole. Fluid-air exchange was then performed. The air was then replaced with 10 % perfluoropropane (C3F8) gas. Comprehensive ophthalmologic examinations and spectral-domain optical coherence tomography were performed preoperatively and postoperatively. The main outcome measures were best-corrected Snellen visual acuity (BCVA) and MH closure rate.
  
  
  RESULTS
  The preoperative mean base diameter of the MHs was 1637.6 + 412.7 μm (range, 814-2092 μm). The preoperative mean minimum diameter was 814.4 + 255.0 μm (range, 546 μm-1485 μm). Complete MH sealing was achieved in 12 eyes after transplantation of the ILM flap. The mean BCVA was 1.15 + 0.21 (range, 1.0-1.6) before surgery and 0.99 + 0.17 (range, 0.7-1.3) at 12 months postoperatively. There was a significant difference in BCVA before versus after the surgery (t = 3.825, P = 0.0002, paired t- test).
  
  
  CONCLUSIONS
  Transplantation of autologous ILM is an effective addition to the surgical options for large macular holes after failed surgeries with ILM removal.
authors: Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Road, DongCheng District, Beijing, 100730, China.|Shanxi Eye Hospital, Taiyuan, Shanxi, China.
authors: Yining
authors: Y
authors: Dai
authors: Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Road, DongCheng District, Beijing, 100730, China. d_fangtian@sina.com.
authors: Fangtian
authors: F
authors: Dong
authors: Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Road, DongCheng District, Beijing, 100730, China.
authors: Xiao
authors: X
authors: Zhang
authors: Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Road, DongCheng District, Beijing, 100730, China.
authors: Zhikun
authors: Z
authors: Yang
mesh_terms: D000328:Adult; D000368:Aged; D001485:Basement Membrane / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D012086:Reoperation; D012167:Retinal Perforations / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult
keywords: Internal limiting membrane; Macular hole; Pars plana vitrectomy; Re-operation