| 본문 : Purpose: The aim of this study was to demonstrate the surgical technique and clinical outcome of autologous retinal free flap transplantation for recurrent macular hole retinal detachment (MH RD).
Methods: The clinical course of a case was retrospectively evaluated according to a chart review.
Results: A 71-year-old female had undergone pars plana vitrectomy (PPV), ILM peeling, endolaser photocoagulation at the margin of the hole with silicone oil tamponade for repair of myopic MH RD in June 2010. Silicone oil was removed 3 months postoperatively and the retina attached well with corrected visual acuity of 20/200. Unfortunately, retinal redetachment with large MH developed eight years after surgery.
The patient underwent 25-gauge 3-port PPV under general anesthesia. During surgery, we found that macular hole was about 1.5 disc diameter in size. A retinal flap harvest site was selected in mid periphery of superior detached retina. Endodiathermy was applied to outline the retinal free flap. The neurosensory retinal free flap was approximately twice the diameter of the MH. The retina was cut with vertical scissors along the marked edge of the retinal flap until a small attachment was left (hinge). A hinge helped minimize disruption or loss of the flap during fluid-air exchange.
After fluid-air exchange, a drop of viscoelastics was placed within the MH, and the hinge of retinal free flap was gently dissected and then it was placed on the MH. Flap edges were gently flattened and it was stretched to lay flat and cover the entirety of the hole. Endolaser was applied in a circular manner around a harvest site. Silicone oil was injected at the end of the surgery. The patient was instructed to maintain a prone position for 2 weeks postoperatively.
The 1-week postoperative OCT showed MH closure with the flap visualized as a distinct hyperreflective layer that was stable at 1 month. The patient reported a decrease in her scotoma area.
Conclusions: Autologous retinal free flap transplantation is an effective addition to the surgical options for recurrent MH RD. |