Prognostic Factors in Patients with Persistent Full-Thickness Idiopathic Macular Holes Treated with Re-Vitrectomy with Autologous Platelet Concentrate.

PURPOSE: To identify the predictors for anatomical and functional outcome after re-vitrectomy with application of autologous platelet concentrate (APC) in eyes with persistent idiopathic macular hole (MH). METHODS: Retrospective study of 103 eyes with persistent MHs after vitrectomy with peeling of internal limiting membrane (ILM) and expansive gas. All patients underwent re-vitrectomy with APC and endotamponade. The anatomical MH closure rate and postoperative best-corrected visual acuity (BCVA) were evaluated. Further, predictive factors influencing the success of the surgery were analyzed. RESULTS: Median BCVA (logMAR) before the surgery was 1.00 (interquartile range [IQR] 0.80-1.30) and the median of minimum diameter between hole edges was 508 µm (IQR 387-631). The final closure rate after re-vitrectomy with APC was 60.2% (62 of 103 eyes). The following predictors were identified to significantly influence the closure rate: tractional hole index (THI), axial length, time between first and second surgery, and the experience of the surgeon (p < 0.05). CONCLUSIONS: Re-vitrectomy with APC led to the closure of 60.2% of the persistent MHs. The closure rate negatively correlates with increasing axial length, time between the first and second surgery, and the decreased THI. Further, experienced surgeons (with a history of >100 pars plana vitrectomies with ILM peeling) had significantly higher closure rates.

Persistent Full-Thickness Idiopathic Macular Hole: Anatomical and Functional Outcome of Revitrectomy with Autologous Platelet Concentrate or Autologous Whole Blood.

PURPOSE: To evaluate long-term outcome after revitrectomy with autologous platelet concentrate (APC) or whole blood (WB) in persistent idiopathic macular hole (MH) after vitrectomy with internal limiting membrane (ILM) peeling. PROCEDURES: Retrospective study of 75 eyes with persistent MH after vitrectomy with ILM peeling and gas. All patients underwent revitrectomy with gas and APC (n = 61) or WB (n = 14). Main outcome measures were anatomical closure rate and postoperative best-corrected visual acuity (BCVA). RESULTS: Closure rate after revitrectomy was 85.2% (52/61) in the APC group and 7.1% (1/14) in the WB group. Median follow-up was 58 (range 3-147) months. Median BCVA (logMAR) in patients with finally closed MHs was 0.4 ± 0.3. Patients with defects of the ellipsoid zone had significantly worse postoperative BCVA. Morphological MH configuration (atrophic or elevated edges) did not correlate with final closure rate. CONCLUSIONS: Revitrectomy with APC and gas is a very effective treatment in persistent MH after vitrectomy with ILM peeling and gas.

Short-term results of platelet-rich plasma as adjuvant to 23-G vitrectomy in the treatment of high myopic macular holes.

PURPOSE: To investigate the short-term safety and efficacy of autologous platelet-rich plasma (a-PRP) as adjuvant to pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling in the treatment of highly myopic macular holes (MH). METHODS: This was a prospective, nonrandomized interventional case series. Patients with MH associated with high myopia, with or without previous PPV, were included. All patients underwent 23-G PPV with the use of a-PRP. Anatomical and functional results of surgery were recorded. RESULTS: We included 7 eyes of 6 patients with highly myopic MH. Primary anatomical success was achieved in 7 out of 7 eyes. Mean best-corrected visual acuity improved by more than 1 line from baseline (0.66 ± 0.36 LogMAR) to final visit (0.52 ± 0.25 logMAR), but with no statistically significant difference (p = 0.246, Wilcoxon test). No surgical-related complications were noticed. CONCLUSIONS: The use of a-PRP as adjuvant to PPV with ILM peeling is effective in the treatment of highly myopic MH. This approach may represent a valid alternative to the inverted ILM flap technique, with comparable visual and anatomical results and the advantage of a simpler procedure. Further studies are necessary to confirm its usefulness in the management of high myopic MH.

Treatment of recurrent retinal detachment secondary to optic nerve coloboma with injection of autologous platelet concentrate.

A 14-year-old girl presented with a recurrent retinal detachment secondary to optic nerve coloboma in her left eye with a small retinal hole in the bed of the coloboma, confirmed by optical coherence tomography. The patient was treated by injection of 0.05 mL of autologous platelet concentrate into the coloboma along with vitrectomy and gas exchange. After 8 months, the retina was attached and optical coherence tomography revealed closure of the retinal hole. Considering our experience, autologous platelet injection may be considered a treatment option for recurrent retinal detachment secondary to optic nerve coloboma.

Twenty-three-gauge pars plana vitrectomy, Densiron-68, and 360° endolaser versus combined 20-gauge pars plana vitrectomy, scleral buckle, and SF6 for pseudophakic retinal detachment with inferior retinal breaks.

PURPOSE: To compare the anatomical and functional outcomes of 23-gauge pars plana vitrectomy (PPV) with Densiron-68 tamponade and 360° endolaser versus 20-gauge PPV with encircling scleral buckling (ESB) and an SF6 gas tamponade for the repair of primary pseudophakic retinal detachment with inferior retinal breaks. METHODS: Prospective, randomized, comparative, interventional study. Eighty-two eyes of 82 consecutive patients were randomly assigned to 1 of the 2 treatment groups: 23-gauge PPV/Densiron-68 (44 eyes, 54%) or 20-gauge PPV/ESB/SF6 (20%) (38 eyes, 46%). The inclusion criterion was the presence of primary pseudophakic retinal detachment with at least 1 retinal break between the 4- and 8-o'clock positions. The study protocol involved a minimum of 7 visits: baseline, day of surgery, 1 week, and 1, 3, 6, and 9 months postoperation. Densiron-68 removal was performed within 12 weeks of the initial surgery. Two surgical procedures were required in the Densiron group to remove the oil. RESULTS: After the primary procedure, the retina was reattached in 90% (40 of 44) of cases in the 23-gauge PPV/Densiron group and in 92% (35 of 38) of cases in the 20-gauge PPV/ESB/SF6 group (P = 0.2, Fisher's exact test). After resolution of redetachments, final anatomical success rate rose to 97% (43 of 44) in the 23-gauge PPV/Densiron group and 94% (36 of 38) in the 20-gauge PPV/SB/SF6 group (P = 0.32, Fisher's exact test). Mean final best-corrected visual acuity (logarithm of the minimum angle of resolution) was 0.40 in the 23-gauge PPV/Densiron group and 0.48 in the 20-gauge PPV/ESB/SF6 group (P = 0.31, t-test). Operative time was significantly less in the 23-gauge PPV/Densiron group (P = 0.002, t-test). No statistically significant difference in the complication rate between the two groups was recorded. CONCLUSION: Twenty-three-gauge PPV combined with Densiron-68 and 360° endolaser and 20-gauge PPV combined with ESB/SF6 seemed to have similar efficacy in the repair of primary pseudophakic retinal detachment. Supplementary scleral buckling can be avoided using a Densiron-68 tamponade for retinal detachment with inferior retinal breaks.

[Sudden visual loss following silicone oil removal: three patients treated for giant retinal tear]. / Perte brutale d'acuité visuelle post-ablation de silicone: à propos de trois patients traités pour déchirure géante.

INTRODUCTION: We report three cases of sudden visual loss after removal of silicone oil in patients treated for retinal detachment with giant retinal tear. PATIENTS AND METHODS: Three patients were operated for retinal detachment associated with giant retinal tear. We performed vitrectomy and silicone oil tamponade. Silicone oil was removed a few months later with no complications. RESULTS: All three patients complained of sudden visual loss immediately after removal of silicone oil. Clinical examinations, angiography, and OCT were normal. Electroretinograms and visual field showed central macular dysfunction in all three cases. Long-term follow-up contributed no complementary information or functional improvement. DISCUSSION: We report a rare complication due to the use of silicone oil, with no obvious etiology. Several hypotheses were formulated. Sudden changes in potassium concentration in retro-fluid oil may lead to macular dysfunction when silicone oil is removed. A comparison between our patients and other series in the literature raised the suspicion of risk factors for this complication: young age and macula-on retinal detachment associated with giant retinal tear. CONCLUSION: Better knowledge of the physiopathology of giant retinal tears could lead to a better understanding of this rare complication.

Anatomical success rate of macular hole surgery with autologous platelet without internal-limiting membrane peeling.

AIM: To describe our experience and success rate of macular hole surgery with pars plana vitrectomy with autologous platelet and without internal limiting membrane peel. METHODS: Retrospective review of 56 consecutive patients who underwent macular hole surgery. RESULTS: Anatomical success was achieved in 55 out of 56 patients (98.2%). Functional success was achieved in 37 out of 56 patients (66.1%). A total of 21 patients (37.5%) achieved postoperative visual acuity of 6/12 or better. No intraoperative complications were encountered. Postoperative complications included cataract progression in eight eyes and raised intraocular pressure in 20 eyes. CONCLUSIONS: Our success rate was comparable to that reported in macular hole surgery incorporating internal limiting membrane (ILM) peel or with autologous platelet without ILM peel.

Preparation of autologous platelets for the ophthalmologic treatment of macular holes.

BACKGROUND: Platelet concentrates were recently used for ophthalmologic treatment of macular holes. This strategy was investigated to define standardized blood bank components. STUDY DESIGN AND METHODS: Two different, highly concentrated autologous platelet components, one from whole-blood preparation and the other from plateletpheresis, were evaluated. In the first procedure, platelet-rich plasma was obtained from 250 mL of whole blood. After storage for 20 hours, platelet-rich plasma was concentrated in a second centrifugation step and adjusted to 10 x 10(9) platelets per mL. In the second procedure, platelets were collected by apheresis, stored overnight, centrifuged, and adjusted to 20 x 10(9) platelets per mL. The respective component was instilled during vitrectomy and gas tamponade in patients with stage II to IV macular holes. Patients were followed for 9 months. RESULTS: With regard to the various preparation procedures and final concentrations of platelets in the components, no differences in wound healing were observed. An anatomic closure of the macular hole was achieved in 18 of 19 treated patients. Visual acuity improved in 14 patients. CONCLUSION: Both types of highly concentrated platelet components were effective in achieving high closure rates of macular holes. These autologous platelet components possess the quality standard of blood bank components and could be of great benefit for initiating wound healing in other clinical settings.

Surgical management of macular holes: results using gas tamponade alone, or in combination with autologous platelet concentrate, or transforming growth factor beta 2.

BACKGROUND: Vitrectomy and gas tamponade has become a recognised technique for the treatment of macular holes. In an attempt to improve the anatomic and visual success of the procedure, various adjunctive therapies--cytokines, serum, and platelets--have been employed. A consecutive series of 85 eyes which underwent macular hole surgery using gas tamponade alone, or gas tamponade with either the cytokine transforming growth factor beta 2 (TGF-beta 2) or autologous platelet concentrate is reported. METHODS: Twenty eyes had vitrectomy and 20% SF6 gas tamponade; 15 had vitrectomy, 20% SF6 gas, and TGF-beta 2; 50 had vitrectomy, 16% C3F8 gas tamponade, and 0.1 ml of autologous platelet concentrate prepared during the procedure. RESULTS: Anatomic success occurred in 86% of eyes, with 96% of the platelet treated group achieving closure of the macular hole. Visual acuity improved by two lines or more in 65% of the SF6 only group, 33% of those treated with TGF-beta 2 and in 74% of the platelet treated group. In the platelet treated group 40% achieved 6/12 or better and 62% achieved 6/18 or better. The best visual results were obtained in stage 2 holes. CONCLUSION: Vitrectomy for macular holes is often of benefit and patients may recover good visual acuity, especially early in the disease process. The procedure has a number of serious complications, and the postoperative posturing requirement is difficult. Patients need to be informed of such concerns before surgery.

Autologous platelet concentrate as an adjunct in macular hole healing: a pilot study.

PURPOSE: A pilot study was undertaken to assess the efficacy of autologous platelets in macular hole healing. PATIENTS AND METHODS: Eight eyes of eight patients with stage 3 or 4 macular holes, two of which had failed to heal after previous vitrectomy and gas tamponade, were included. The procedure consisted of pars plana vitrectomy with removal of posterior cortical vitreous, stripping of associated epimacular membranes, 15% perfluoroethane-air tamponade, and instillation of autologous platelet concentrate onto the posterior pole. Strict postoperative facedown positioning was observed for 12 days. Postoperative evaluation included visual acuity measurement, biomicroscopic macular appearance and scanning laser ophthalmoscope examination. The follow-up period ranged from 3 to 13 months (mean, 7 months). RESULTS: Of eight eyes, flattening of the surrounding retina and closure of the hole were achieved in seven (87.5%). Visual acuity improved two lines or more in four eyes (50%) Four eyes (50%) reached a postoperative visual acuity of 20/50 or more. Increased nuclear sclerosis was observed in six eyes (75%), and retinal detachment occurred in two eyes (25%). CONCLUSIONS: Autologous platelet concentrate administered peroperatively in full-thickness macular holes seems to be a safe and effective adjunct to vitrectomy with removal of posterior hyaloid and gas tamponade. A larger multicenter randomized prospective study is underway to verify these encouraging results before advocating the use of autologous platelets in macular hole surgery.

Surgical treatment of full-thickness macular holes using autologous serum.

BACKGROUND: Full-thickness macular holes (FTMH) are an important cause of visual loss in older patients. Recognition of tangential vitreofoveal traction as the mechanism of hole formation has led to the use of vitrectomy and gas tamponade as a treatment for macular holes. The use of growth factors as an adjunctive therapy to promote chorioretinal adhesion and hole closure has also been advocated. METHODS: Forty-four consecutive patients undergoing vitrectomy, posterior hyaloid removal, gas injection and installation of autologous serum for FTMH were studied prospectively. Patients' age, sex, duration of symptoms, best corrected pre- and post-operative Snellen visual acuities, best corrected acuity in the fellow eye, stage of macular hole, post-operative closure or persistence of the macular hole, and intra- and post-operative complications were recorded. RESULTS: Of 43 patients with adequate follow-up (minimum 6 weeks, mean 6.1 months) anatomical closure of the macular hole was achieved in 29 eyes (67%). The average visual improvement in these eyes was 2.7 lines. Twenty eyes (69%) with closed holes had visual acuity of 6/12 or better (47% of all patients undergoing surgery). Of the 14 eyes (33%) that failed, the average loss of vision was 0.4 lines and all these eyes had vision of 6/36 or worse. CONCLUSIONS: In this series, surgical treatment of FTMH with vitrectomy, gas injection and autologous serum resulted in closure of the macular hole in two-thirds of patients and restored central vision in about one-half of patients. These results compare favourably with previously reported results of macular hole surgery. The answer to the question whether the use of autologous serum leads to a higher closure rate than surgery with gas tamponade alone requires information from randomised treatment trials, one of which is currently in progress.

Surgery for idiopathic full-thickness macular holes.

BACKGROUND: Idiopathic full-thickness macular holes (FTMH) are an important cause of loss of central vision in the elderly. Improved understanding of the natural history and pathophysiology of FTMH has led to recent advances in the surgical management of patients with this hitherto untreatable condition. METHODS: The current concepts of the natural history and surgical treatment are reviewed. Pilot studies of vitrectomy undertaken to relieve the tangential traction at the vitreomacular interface and the role of growth factors as promoters of a limited healing response are reviewed and illustrated by the results of surgical treatment of macular holes obtained by the author and others. RESULTS: Whereas early pilot studies of vitrectomy of impending (stage I) macular hole suggested beneficial results (80-95% of operated eyes did not progress to FTMH), no such benefit could be demonstrated by a subsequent randomised treatment trial. In a study of early vitrectomy and partial fluid-gas exchange hole closure was achieved in 88% of patients with stage II FTMH with visual improvement in 67%. In other studies of FTMH (stages II-IV) the addition of adjunctive substances such as growth factors, autologous serum, plasma or platelet concentrate has resulted in closure in 77-100% of cases. However, similar results have also been reported with vitrectomy and gas tamponade alone. Histologically the closure of the FTMH is associated with glial proliferation. CONCLUSION: Vitrectomy and intraocular tamponade appear to be beneficial in patients with FTMH. The role of adjunctive substances, such as growth factors and other promoters of the healing response, requires clarification by randomised treatment trials.