Long-term results following pars plana vitrectomy with platelet concentrate in pediatric patients with traumatic macular hole

Abstract

67% to 85% were achieved in adults with traumatic macular hole (MH) by pars plana vitrectomy and gas instillation with or without adjuvants. 1-4 Some reports 5 have described spontaneous closure of traumatic macular holes in children and young adults.The purpose of this report is to describe the long-term clinical course in children following treatment of traumatic macular hole with pars plana vitrectomy and platelet concentrate.Four male pediatric patients underwent pars plana vitrectomy with platelet concentrate and SF6 gas tamponade for traumatic macular hole repair after a blunt trauma.The boys had a mean age of 13.2 years (range, 10 -15 years). A stage 3 macular hole according to Gass with a diameter of at least 300 m was diagnosed in all patients.The mean follow-up was 35.2 months (range, 27-51 months).The surgical technique included a standard three-port pars plana vitrectomy, peeling of the epiretinal membrane including the internal limiting membrane (ILM), injecting a drop of freshly obtained autologous platelet concentrate (4ϫ10 9 thrombocytes/ml) into the macular hole, and instilling 25% SF6 gas (Figure 1). 6 The individual patients are presented in Table 1. The mean interval between the diagnosis and the operation was 3 months (range, 1-5 months).Primary closure was achieved by a single intervention in all patients and all patients had a marked visual improvement of Ն three lines (three to seven lines) after surgery. The surgically achieved visual improvement remained stable during follow-up.

Platelet gels and releasates

“…In this report, the authors stated that 'the notably higher macular holeclosure rate in comparison to that seen with other adjuvants points to an interesting new field in which platelet administration might be warranted.' Similar results were obtained by others [47,48]. Ophthalmologic preparations have used platelet concentrations significantly higher than concentrations considered optimal for soft and bony tissue (i.e., 50-100 3 10 8 platelets/ml).…”

Vitrectomy, Inner Limiting Membrane Peel, and Gas Tamponade in the Management of Traumatic Paediatric Macular Holes: A Case Series of 13 Patients

“…Azevedo and colleagues [2] discuss the use of pars plana vitrectomy and ILM peel in the successful closure of 4 paediatric macular holes, providing a substantial improvement in vision in 3 cases. Wachtlin et al [3] report 4 further patients managed by vitrectomy and ILM peel with the additional use of autologous platelet injection. Again, hole closure was universal and 2 of the 4 patients achieved vision of better than 20/50 in the damaged eye.…”

“…Three such case series each include 4 patients; Azevedo and colleagues [2] report 4 paediatric patients treated with pars plana vitrectomy and internal limiting membrane (ILM) peel, all of whom had a successful hole closure. Likewise, Wachtlin et al [3] report 100% hole closure and substantial visual improvement in each of their 4 patients after vitrectomy and ILM peel with use of autologous platelet injection. A further series of 4 patients reported by Margherio et al [4] were managed differently, with autologous plasmin injection prior to vitrectomy.…”

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

“…1,7 More recently, platelet concentrate has been deemed an effective long-term treatment for children with a traumatic macular hole after vitrectomy. 8 Autologous platelet concentrate has both mitogenic and chemotactic properties because of its high level of platelets and a full complement of clotting and growth factors. As an autologous preparation, it is free from transmittable diseases and can be produced as needed from the patient's blood.…”