Lens Capsular Flap Transplantation in the Management of Refractory Macular Hole from Multiple Etiologies.

PURPOSE To report the clinical results of lens capsular flap transplantation in refractory macular hole (MH). METHODS This retrospective, interventional, consecutive case series included 20 eyes with persistent MH after previous standard MH surgery. All eyes underwent vitrectomy, lens anterior or posterior capsule transplantation into the MH, gas tamponade, and a 1-week postoperative head down. Structural and functional changes were evaluated. RESULTS The predisposing conditions to surgical failure included high myopia with MH and retinal detachment in four eyes, MH after myopic foveoschisis surgery in one eye, high myopia with a large MH in one eye, proliferative diabetic retinopathy with MH in three eyes, MH with severe retinal detachment in one eye, retinal detachment with concurrent peripheral breaks and MH in one eye, and large or chronic MH in nine eyes. Macular hole was closed in all the 10 eyes receiving anterior capsular flap transplantation. In the 10 eyes with posterior capsular flap transplantation, MH was closed in 5, partially closed in 3, and not closed in 2. Visual acuity in logarithm of minimal angle of resolution improved from 1.53 ± 0.39 preoperatively to 1.07 ± 0.35 postoperatively. CONCLUSION Lens capsular flap transplantation may close the MH and improve visual outcome in the majority cases of refractory MH.