Our Summary

This research paper discusses a surgical procedure performed in Hungary to treat a patient with a severe macular hole, a condition where a hole forms in the part of the eye responsible for sharp, detailed vision. This hole can significantly affect a person’s vision and in some cases, can be very challenging to treat, with about 5% of patients not responding to initial treatments.

The patient in this study had a large macular hole that did not improve despite initial surgery. The surgeons decided to perform a new technique called autologous neurosensory retinal transplantation. This means they took a piece of the patient’s own retina and transplanted it into the hole. This was the first time this procedure was performed in Hungary.

To keep the transplant in place, a substance called decalin was left in the eye, which required the patient to remain lying face-up for five days. This decalin was later removed in another operation and replaced with a gas filling.

Eight weeks after the surgery, the macular hole was closed, and the patient’s vision improved from 4% to 20% - a significant improvement. This improvement remained stable over a six-month follow-up period.

The paper concludes that this innovative surgical procedure could be a beneficial treatment option for patients with treatment-resistant macular holes. However, they note that more research is needed to fully understand when this surgery should be used.

FAQs

  1. What is autologous neurosensory retinal transplantation?
  2. What is the role of decalin in the surgical procedure and why was it replaced with a gas filling?
  3. What were the outcomes of the surgery and how did it impact the patient’s vision?

Doctor’s Tip

A helpful tip a doctor might tell a patient about retinal surgery is to follow post-operative instructions carefully to ensure the best possible outcome. This may include keeping the eye clean, avoiding strenuous activities, and attending follow-up appointments to monitor progress. It is important to communicate any changes in vision or discomfort to your doctor promptly.

Suitable For

Patients who are typically recommended retinal surgery are those with severe macular holes that do not respond to initial treatments, such as medications or standard surgical techniques. These patients may experience significant vision loss and impairment in their daily activities. Retinal surgery may be considered as a last resort to improve vision and quality of life for these individuals.

In this case study, the patient had a large macular hole that did not improve with initial surgery, leading the surgeons to perform a novel technique to transplant a piece of the patient’s own retina into the hole. This procedure was successful in closing the macular hole and improving the patient’s vision.

Patients with severe macular holes, retinal detachments, diabetic retinopathy, macular degeneration, and other retinal disorders may benefit from retinal surgery to improve their vision and prevent further vision loss. It is important for these patients to consult with a retinal specialist to determine the most appropriate treatment options for their specific condition.

Timeline

Overall timeline of the patient’s experience before and after retinal surgery:

  • Initial diagnosis of severe macular hole
  • Initial surgery performed, but hole does not improve
  • Decision made to perform autologous neurosensory retinal transplantation
  • Transplant performed, with decalin left in the eye for five days
  • Decalin removed and replaced with gas filling in another operation
  • Eight weeks post-surgery, macular hole closed and vision improved from 4% to 20%
  • Vision improvement remains stable over a six-month follow-up period
  • Conclusion drawn that surgery could be a beneficial treatment option for patients with treatment-resistant macular holes, but more research is needed.

What to Ask Your Doctor

  1. What is the success rate of this surgical procedure for patients with macular holes?
  2. Are there any potential risks or complications associated with this surgery?
  3. What is the recovery process like after this surgery?
  4. How long does it typically take for vision to improve after the surgery?
  5. Are there any specific post-operative care instructions I should follow?
  6. Will I need any follow-up appointments after the surgery?
  7. Are there any alternative treatment options available for my condition?
  8. What are the chances of the macular hole reopening after the surgery?
  9. How experienced are you in performing this specific type of retinal surgery?
  10. Can you provide me with any additional information or resources about this surgical procedure?

Reference

Authors: Bokor Á, Makhoul S, Pásztor O, Fodor M. Journal: Orv Hetil. 2023 Sep 24;164(38):1511-1517. doi: 10.1556/650.2023.32879. Print 2023 Sep 24. PMID: 37742218