Long-term results of autologous plasma as adjuvant to pars plana vitrectomy in the treatment of high myopic full-thickness macular holes

Abstract

Background: To analyse the feasibility and efficacy of a novel autologous plasma rich in growth factor (PRGF) preparation as adjuvant to pars plana vitrectomy and internal limiting membrane peel in high myopic full-thickness macular hole (FTMH). Methods: Single-centre, single-surgeon retrospective chart review of consecutive patients with high myopic FTMH who underwent surgery with a minimum follow-up of 12 months. Patients were divided in group 1 (naïve) and group 2 (persistent). Quantitative and qualitative variables were analysed, compared among groups and correlated with best corrected visual acuity (BCVA). Results: Postoperatively, FTMH resolved in 28/31 eyes in group 1 (90%) and in 10/11 eyes in group 2 (91%), without significant differences ( p = 0.954). None of the preoperative anatomical variables analysed showed significant association with preoperative BCVA. Intraoperatively, no significant complications were registered. Postoperatively, BCVA improved significantly in the studied population ( p < 0.001). Preoperative factors associated with better postoperative BCVA were the presence of intraretinal cystoid spaces ( p = 0.028) and elevated FTMH borders ( p = 0.005). Preoperative dome-shaped macula was associated with significantly worse postoperative BCVA ( p = 0.049). Conclusion: The use of PRGF as adjuvant to vitrectomy showed to be reproducible, straightforward and efficient, with primary anatomical success rate comparable to other surgical approaches and lower risk of complications.

Repeat Surgery following Temporal Inverted ILM Flap Technique: Next Step after Primary Failure

“…Following the standard method with ILM peeling and facedown positioning, repeat surgery of a persistent hole is mostly performed with revisional PPV with or without ILM peeling enlargement, which acts by removing the residual tangential tractions 9 , 19 . Other methods used in revisional surgery might be mentioned as induced retinal detachment through subretinal fluid injection, which releases the adhesions between the retracted retina and retinal pigment epithelium 20 , application of autologous blood products that modulate intraretinal gliosis through growth and neurotrophic factors 21 , and techniques that serve as plugging the hole and creating a scaffold for Müller cell migration and proliferation like free ILM flap, lens capsular flap, free retinal graft, or human amniotic membrane transplantation 19 , 22 , 23 , 24 , 25 . In general, among the multiple available surgical procedures, the surgeonʼs experience and preference determines the method selection.…”

A Case of Closure of Recurrent Full-Thickness Macular Hole by Spontaneous Retinal Detachment around the Macular Hole and Gas Tamponade

“…Although the reported closure rate of FTMH exceeds 95% [ 5 ], refractory cases persist. These cases have prompted attempts at additional interventions, such as extensive ILM peeling [ 6 ], inverted ILM flaps [ 7 ], autologous neurosensory retinal-free flap application [ 8 ], outpatient fluid-gas exchange (FGX) [ 9 ], and autologous platelet concentrates [ 10 ]. Notably, some study suggested that firm adhesion between photoreceptors and the retinal pigment epithelium hinders FTMH closure, leading to subretinal adhesion release using subretinal fluid applications [ 11 , 12 ].…”

Comparison of anatomical and functional outcomes of different surgical techniques in myopic macular hole without retinal detachment

“…The occurrence of posterior staphyloma, the elongation of the axial length and epiretinal membrane formation render this surgery challenging and may elicit lower success rates. The inelasticity of the retinal blood vessels and internal limiting membrane (ILM) have also been considered to be an important factor in myopic MH surgery [2] . Several surgical methods have been defined to improve the outcomes of pars plana vitrectomy (PPV) and ILM peeling in the treatment of myopic, unclosed and large MHs, including free ILM patch transplantation and inverted ILM flap technique [3][4] .…”