Autologous Neurosensory Retinal Free Flap for Closure of Refractory Myopic Macular Holes

Macular holes (MHs) in highly myopic patients often develop at a younger age and may be associated with foveoschisis and a posterior retinal detachment (RD), which portend a poorer prognosis.Although recent anatomical success following primary pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peel with gas tamponade have improved to 60% to 100%, closure rates are significantly lower if associated with foveoschisis or RD, the MH may attain a flat-open configuration even following retinal reattachment, and reopening rates are higher. 1,2arly treatment reports described perifoveolar laser photocoagulation to form chorioretinal adhesions resulting in permanent photoreceptor loss. 3Several procedures are now available for primary repair of myopic MH and MH RD including PPV with ILM peel and gas or silicone oil tamponade, inverted ILM flaps, 4,5 episcleral posterior buckling, adjuvant blood components, 6 suprachoroidal buckling, and scleral shortening techniques. 7However, options for patients whose MHs fail to close despite initial PPV and ILM peel are limited.Techniques described recently include temporal scleral imbrication, 8 autologous ILM flap, 5 addition of autologous blood to the autologous ILM flap, 9 and autologous anterior or posterior lens capsule flap as a scaffold to plug the MH. 10 We describe a new technique involving the use of an autologous neurosensory retinal free flap for closure of refractory myopic MHs with associated foveoschisis and/or RD.This technique involves harvesting an autologous neurosensory retinal free flap and positioning it over the refractory MH to provide a scaffold and plug for hole closure.