Efficacy of autologous platelets in macular hole surgery

Abstract

The introduction of optical coherence tomography has allowed accurate measurement of the size of macular holes. A retrospective consecutive review was performed of 21 patients undergoing macular hole repair with vitrectomy, gas tamponade, and autologous platelet injection and we assessed the effect of macular hole parameters on anatomic and functional outcomes. We looked at the demographic features, final visual outcome, and anatomical closure. Twenty-one patients were included in the study. They underwent routine vitrectomy with gas tamponade (C3F8) and injection of autologous platelets. All patients were advised to maintain a facedown posture for 2 weeks. Anatomical closure was confirmed in all cases and 20 out of 21 of patients had improved postoperative visual acuity by two or more lines. In our series, the macular hole dimensions did not have much effect on the final results. The use of autologous platelets and strict facedown posture seems to be the deciding factor in good anatomical and visual outcome irrespective of macular hole dimensions.

Predicting Visual Outcome following Surgery for Idiopathic Macular Holes

“…Table 1 shows the representative OCT parameters repeatedly discussed in previous papers in terms of their potential as preoperative predictors for postoperative visual outcomes. The minimum diameter of MH, also known as the minimum linear dimension of MH, is identical to the above-mentioned MH size, one of the most studied OCT parameters so far [52,56,57,58,59,60,61,62,63,64]. Commonly, a smaller minimum diameter is associated with better postoperative visual acuity, irrespective of the presence/absence of a statistical significance.…”

“…Although both the minimum diameter and basal hole diameter appear to be widely accepted as helpful for predicting visual outcomes following MH surgery, one report giving a contrary conclusion should be kept in mind. In a case series of 21 eyes that underwent MH surgery with C 3 F 8 gas tamponade and autologous platelet injection, no correlation was found between the minimum diameter and the visual acuity or visual improvement at 6 postoperative months [63]. The hole height is another preoperative OCT parameter, defined as the greatest distance between the retinal pigment epithelium layer and the vitreoretinal interface.…”

“…The hole height is another preoperative OCT parameter, defined as the greatest distance between the retinal pigment epithelium layer and the vitreoretinal interface. Previous studies concluded that there is no significant relationship between the hole height and postoperative visual outcomes [58,59,61,63,64,65], with the exception of one retrospective study showing a negative correlation between the hole height and visual acuity more than 5 years after MH surgery [58]. The photoreceptor inner segment/outer segment (IS/OS) junction line can be better recognised as a hyperreflective band by spectral domain OCT imaging, and the relationship between the length of the IS/OS junction defect and visual outcomes was recently investigated; although there is a debate as to whether this hyperreflective band corresponds to the IS/OS junction [66], the term ‘IS/OS junction' is used in this review.…”

Wirkung von autologem Thrombozytenkonzentrat auf den anatomischen und funktionellen Erfolg bei der Chirurgie des Makulaforamens im Spätstadium

“…Andererseits spielt auch der geringe Erkenntnisgrad zur Pathologie und Wundheilung des Makulaforamens eine Rolle. Es gibt nur wenige vergleichende Studien zum Einsatz von Thrombozytenpräpara-ten [14,18,25], die allerdings alle einen z. T. auch signifikanten Vorteil bezüglich des anatomischen Erfolgs zeigen. Auffallend ist, dass sich aber nur wenige Studien vorrangig mit dem funktionellen Erfolg, also mit der Erholung der Sehkraft, beschäftigen, die ja gerade für die Patienten entscheidend ist.…”

“…Dabei gab es bereits sehr früh zellbiologische, auf die Wundheilung orientierte Ansätze. So wurden durch die Verwendung biologischer Adjuvantien (wie Serum), einzelner Wachstumsfaktoren oder auch von autologem Thrombozytenkonzentrat versucht den anatomischen Erfolg (Lochverschluss) zu steigern, wobei Letzteres besonders gute Ergebnisse brachte [14,18]. In den vergangenen Jahren wurden diese Konzepte von den Retinologen jedoch immer seltener angewendet.…”