First Author: K.Furuya JAPAN
Co Author(s): H. Nakashizuka H. Onoe Y. Kitagawa H. Shimada
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To report anterior and posterior lens capsular flap transplantations, for refractory retinal diseases, which achieved good outcomes.
Lens capsular flap transplantation for refractory macular hole (MH) and the inverted internal limiting membrane (ILM) flap technique for macular detachment with optic disk pit have been reported.
Case 1: A 70-year-old woman presented with a 3-year history of decreased right-eye vision. There was an optic disc pit in the right fundus, with a macular detachment and schisis. The optic disc pit was detected by optical coherence tomography (OCT) angiography. She underwent combined phacoemulsification and intraocular lens (IOL) implantation and 27-gauge pars plana vitrectomy (PPV) without ILM peeling. Triamcinolone acetonide-assisted PPV revealed preexisting posterior vitreous detachment during the surgery. Intraoperatively, sodium chondroitin sulfate-sodium hyaluronate (Viscoat®) was applied to the optic disc, and the anterior lens capsule was then transplanted onto the optic disc and covered with Viscoat®. Perfluoropropane tamponade was conducted, followed by one day prone positioning. Case 2: An 84-year-old woman with a pseudophakic eye presented with a 1-month history of left-eye visual loss. The left fundus showed retinal detachment with MH. She underwent 25-gauge PPV. Coverage of the MH by the inverted ILM technique failed as the MH was too large and the ILM was fragile. We thus conducted posterior lens capsular transplantation onto the MH with purified perfluoro-n-OCT-Ane liquid (Peruluoron®). Fluid-air exchange was conducted from the intentional drainage at the upper retina, followed by perfluoropropane tamponade and prone positioning for one day.
In case 1, an anterior lens capsular flap on the optic disc pit was detected by OCT postoperatively and both macular detachment and schisis rapidly resolved. In case 2, the posterior lens capsular flap on the MH was revealed by OCT and retinal detachment resolved.
Anterior and posterior lens capsular flap transplantation is useful as an adjuvant treatment for refractory retinal diseases.