Tuck-in tenon patch graft for giant full-thickness macular holes

TL;DR

A new surgical technique using a Tenon patch graft successfully closed giant macular holes in three patients with no adverse effects.

Contribution

The novel use of autologous Tenon patch grafts for giant full-thickness macular holes is introduced and evaluated.

Findings

The Tenon patch graft successfully closed macular holes in all three cases.

Functional improvement was observed in all patients during follow-up.

No adverse effects were reported during or after the procedures.

Abstract

To report the results of using autologous Tenon patch grafts for managing giant full-thickness macular holes (FTMHs) when other alternatives are not applicable.

The same surgical technique was performed in all three cases. Briefly, a small fragment of Tenon’s tissue was collected. The graft was introduced through a 23G trocar and released over the macular hole under a bubble of PFCL. The patch is delicately pushed towards the edges of the hole to slide underneath. The PFCL bubble is then actively aspirated next to the optic disc. Tamponade with gas or silicone oil is subsequently injected, with care taken to minimize fluid turbulence during the procedure.

The outcomes of autologous Tenon patch grafts in three giant FTMHs are reported. In the first case, silicone oil tamponade was injected, in the second, C2F6 gas was injected. And in the third case, that of a woman with advanced glaucoma, no tamponade was left in the eye. No adverse effects were observed during or after the procedures. Closure of the macular hole and functional improvement were documented during the follow-up period in all three cases.

With a follow-up of up to 6 months, the Tenon patch graft appeared to be a promising technique for managing complex cases of FTMH. Additional studies to investigate long-term outcomes and determine the most appropriate indications are warranted.

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