To evaluate the surgical outcome of autologous transplantation of internal limiting membrane (ILM) for the treatment of large macular hole.

Twenty-five gauge pars plana vitrectomy was performed for the treatment of patients with full thickness macular hole larger than 400 µm. ILM was stained using 0.025% brilliant blue G. ILM around the hole was circumferentially peeled as large as 2.5 disc diameter (DD) in size and then transplanted inside the hole. ILM was peeled out additionally approximately 1.5 DD in size. Fluid-air exchange and gas injection were performed. After surgery, the hole was scanned using spectral domain optical coherence tomography.

A total of 5 eyes were included in the present study. The mean age was 65.0 ± 11.8 years (52-77) and mean best corrected visual acuity (log MAR) was 0.80 ± 0.27. The mean refractive error was -2.0 ± 2.2 diopter, mean horizontal size of hole was 701.4 ± 129.4 µm, mean vertical size was 630.2 ± 202.8 µm, mean hole base size was 1,043.4 ± 225.0 µm and hole height was 464.4 ± 218.9 µm. At the first day after surgery, transplanted ILM was detected inside the hole in all 5 eyes and complete closure of the hole occurred in 4 eyes. One hole was closed between postoperative days 4 and 7. Foveal contour improved gradually but photoreceptor integrity did not during the follow-up period. Two eyes showed visual improvement but 3 did not after surgery.

Macular hole was closed successfully and quickly using the autologous ILM transplantation technique. Based on our results, the autologous ILM should be considered the treatment of choice for large macular holes.