Outcome of autologous platelet concentrate and gas tamponade compared to heavy silicone oil tamponade in persistent macular hole surgery

Abstract

Purpose: Persistence represents the major reason for failure of primary macular hole repair. A variety of surgical approaches are available for treating persistent macular holes. To compare clinical outcome of re-pars plana vitrectomy combined with autologous platelet concentrate and sulfur hexafluoride 20% gas tamponade with heavy silicone oil in persistent macular hole. Methods: Records of 48 consecutive eyes with persistent macular holes which underwent re-pars plana vitrectomy with either heavy silicone oil (35 eyes, persistent macular–hole minimum linear diameter: 518.8 ± 171.1 µm) or autologous platelet concentrate and sulfur hexafluoride 20% (13 eyes, persistent macular hole–minimum linear diameter: 454.1 ± 211.3 µm) were reviewed retrospectively. All patients underwent measurements of anatomical persistent macular hole characteristics evaluated by optical coherence tomography and visual function. Cases in which anatomical success failed after first re-pars plana vitrectomy were treated with the other surgical techniques, comparable to a cross-over design. Results: Persistent macular hole closure rate was 57.1% with autologous platelet concentrate and sulfur hexafluoride 20% and 45.7% with heavy silicone oil ( p = 0.102). Functional results were comparable when persistent macular hole closure was achieved ( p ⩾ 0.741), but significantly better for the autologous platelet concentrate with sulfur hexafluoride 20% group when persistent macular hole closure failed ( p = 0.019). Conclusion: Re-pars plana vitrectomy combined with autologous platelet concentrate and sulfur hexafluoride 20% seems to achieve at least non-inferior persistent macular hole closure rates and comparable functional results when compared to heavy silicone oil, suggesting autologous platelet concentrate and sulfur hexafluoride 20% as a safe surgical alternative in persistent macular hole. Especially when persistent macular hole closure failed, autologous platelet concentrate with sulfur hexafluoride 20% seems to be superior regarding visual outcome.

Persistent macular holes — what is the best strategy for revision?

“…The silicone oil tamponade Densiron showed a more frequent atrophic closure and foveal architecture remained deranged. This is consistent with other studies that could not show silicone oils to be advantageous [24,33,34]. Only two studies with Densiron showed an exceptionally high anatomical and functional success rate [23,35].…”

Postoperative retinal microstructure and functional outcome after inverted-flap technique associated with silicone oil tamponade in macular hole surgery

“…From the available tamponade options, gas with C 2 F 6 or C 3 F 8 or 20% to 30% SF 6 [ 28 ] is widely used with good anatomical and functional results, with Modi et al concluding that SF 6 results are generally comparable to C 3 F 8 , with SF 6 being advantageous in providing faster return to daily routine with lesser duration of tamponade and C 3 F 8 being preferred for reintervention surgeries as it provides better anatomical MH closure rates, although without translation into VA improvements [ 28 ], however with gas tamponade’s recommendation of maintaining a prone position [ 28 ], with Guillaubey et al finding higher closure rates (97.4% vs 87.5%) for patients following prone positioning indications [ 29 ]. Other studies propose alternatives, such as Hasegawa et al proposed air tamponade instead of SF 6 [ 31 ] with similar closure rates (90.1% for SF 6 and 92.3% for room air) under prone positioning until anatomical closure could be confirmed via OCT [ 31 ], Schaub et al autologous platelet concentrate and 20% SF 6 [ 35 ], while Alberti & la Cour found no statistical difference of maintaining the prone position, instead finding importance in achieving sufficient gas filling for effective closure of the MH [ 30 ]. Due to our patients presenting with large average MH-D, which pose surgical challenges in achieving anatomical closure and medical or cooperation difficulty in maintain the prone position, we approached silicone oil tamponade, which has been indicated [ 32 , 33 , 34 , 35 ] in persistent MHs, achieving high rates of MH closure of 92% for Lappas et al [ 33 ] and 90.9% for Li et al [ 34 ].…”

“…Other studies propose alternatives, such as Hasegawa et al proposed air tamponade instead of SF 6 [ 31 ] with similar closure rates (90.1% for SF 6 and 92.3% for room air) under prone positioning until anatomical closure could be confirmed via OCT [ 31 ], Schaub et al autologous platelet concentrate and 20% SF 6 [ 35 ], while Alberti & la Cour found no statistical difference of maintaining the prone position, instead finding importance in achieving sufficient gas filling for effective closure of the MH [ 30 ]. Due to our patients presenting with large average MH-D, which pose surgical challenges in achieving anatomical closure and medical or cooperation difficulty in maintain the prone position, we approached silicone oil tamponade, which has been indicated [ 32 , 33 , 34 , 35 ] in persistent MHs, achieving high rates of MH closure of 92% for Lappas et al [ 33 ] and 90.9% for Li et al [ 34 ]. Silicone oil tamponade does not require maintaining prone positioning and allows for air travel, however, requires a second reintervention for extraction, usually within a time span of at least two months [ 35 ].…”

“…The second intervention was planned between three and six months, for all the patients and consisted of the extraction of silicone oil accompanied (or not, depending on the case) by cataract surgery. We carefully evaluated the patients for complications of silicone oil tamponade, such as inflammation [ 35 ], silicone emulsification [ 33 , 35 ], elevated IOP [ 33 ] and potential development of secondary glaucoma [ 35 ].…”

“…A type of tamponade must be chosen to assure the prevention of fluid leakage from the vitreous, to ensure enough tension to close the macular defect, release the subretinal fluid and assist the glial cells to migrate and close the MH [ 27 ]. Available tamponade options are gas, such as longer-lasting mixtures like Fluoroethane (C 2 F 6 ) or Perfluoropropane (C 3 F 8 ) or shorter-lasting mixtures like 20% or 30% Sulfurhexafluoride (SF 6 ) [ 28 , 29 , 30 ], air [ 31 ], or various densities of silicone oil [ 32 , 33 , 34 , 35 ]. MH post-op surgical complications include retinal breaks or RD, especially in the inferior quadrant [ 36 ], and RPE alterations [ 37 ].…”