Feasibility Study of Decellularized Corneal Lenticule in a Porcine Model for Macular Hole Closure

Introduction: To develop an innovative preclinical full-thickness macular hole (FTMH) model using porcine eyes and to evaluate the feasibility of decellularized human corneal lenticule (hCL) as a novel bio-graft for macular hole closure. Methods: Twenty-five eyes (n = 25) were obtained from pigs euthanized for food consumption and transported to the laboratory within 3 h. Surgical procedures were performed by the same experienced vitreoretinal surgeon using a Leica Proveo microscope (Proveo 8, Leica Microsystems Inc.) with integrated intraoperative optical coherence tomography (iOCT) technology. After core vitrectomy and posterior vitreous detachment, FTMH was induced using diathermy and a vitrectomy probe. hCLs (thickness 100-120 µm), collected from refractive surgery patients, were decellularized and introduced into the vitreous cavity. With the aid of a viscoelastic agent for stability, hCLs were positioned into the FTMH using microsurgical forceps. Placement and integration were evaluated by iOCT and immunofluorescence (IF) analysis. Results: OCT images and IF analysis confirmed the successful creation of FTMHs ex vivo in porcine eyes, demonstrating the feasibility of hole induction in an ex vivo model. Preliminary OCT and IF analyses showed the successful implantation of decellularized hCLs at the FTMH site, which were correctly positioned in the subretinal space between the choroid and the retinal pigment epithelium. Conclusions: Our preliminary results suggest that decellularized hCLs can be successfully implanted to close FTMHs in our preclinical ex vivo model of study, paving the way for future research into bioengineered hCLs for therapeutic purposes. Video available for this article. Video 1: OCT video recordings during the setup of the ex vivo FTMH model with hCL implantation (MP4 157096 kb).