Ophthalmology Science · Nov 2026
Prospective assessment of long-term neurovascular plasticity in autologous retinal grafts for the repair of recurrent macular holes
By Ruggeri ML, Antonio-Aguirre B, Garg AK et al.
Purpose To assess neurovascular changes following autologous retinal transplantation (ART) for macular hole (MH) repair. Design Combined prospective cohort and retrospective case series. Participants Participants in the prospective study had MH >800 μm, or MH of any size after prior surgery. ART cases with 12-month visual acuity (VA) and optical coherence tomography (OCT) data were included in the retrospective cohort. Methods Prospective participants underwent examination at baseline and 1, 6 and 12 months, including VA, OCT, OCT angiography (OCTA), and microperimetry. In the retrospective arm, VA and OCT data were collected. Main Outcome Measures Primary: the proportion of prospective cases with significant intragraft visual function improvement, defined as a pointwise microperimetry sensitivity improvement of >6dB at ≥1 intragraft loci at 12 months. Secondary: graft vicinity microperimetry sensitivity (GVMS) change, intragraft perfusion (IGP), photoreceptor regeneration assessed using adaptive optics OCT (AO-OCT), VA, ellipsoid zone (EZ) integrity, and complications. Results Nine eyes of 9 participants (three prospective and six retrospective) were enrolled. At 12 months, no prospective cases showed significant intragraft visual function improvement. However, one or more perigraft loci in those cases showed ≥6 dB improvement postoperatively. The median GVMS change from baseline to 12 months was +12.40 ± 5.25 dB. All prospective cases showed IGP at 12 months, and structural graft findings included the outer plexiform layer, outer nuclear layer, external limiting membrane, and EZ line. No significant VA changes were observed. AO-OCT did not show intragraft cone photoreceptors in the one eye tested. Complications included graft dislodgement, edge dehiscence, and edge curling. Conclusions In this small study, there was no significant intragraft visual function improvement among prospective cases despite IGP at 12 months. Several perigraft loci showed significant pointwise sensitivity improvement; the average sensitivity in the graft vicinity improved nominally. These results suggest that ART may produce localized improvements in recipient-side (perigraft) function in the first year, which, in our series, did not translate to VA benefit during this period. Graft perfusion and EZ recovery suggest that graft function may improve over time. Hole chronicity, prior surgery, baseline characteristics, surgical technique, and complications may have affected these results.