Treatment of Retinal Breaks with Autologous Serum in an Experimental Model

Christmas, Nancy J.; Skolik, S; Howard, Matthew A.; Saito, Yoshihiro; Barnstable, Colin J.; Liggett, P. E.

doi:10.1097/00006982-199616020-00026

Cited by 3 publications

(4 citation statements)

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“…We chose to study the use of autologous serum because it is readily available and because of the promising results reported by Christmas et al 15 in the laboratory and by Liggett et al 9 in a preliminary report in patients. One concern with the use of such autologous growth factors is sterility and the possibility that there may be an adverse effect on the hole closure rate or that the factor may improve hole closure but might in some way adversely affect vision.…”

Section: Commentmentioning

confidence: 99%

A Multicentered Clinical Study of Serum as Adjuvant Therapy for Surgical Treatment of Macular Holes

Banker¹

1999

Arch Ophthalmol

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Objective: To evaluate and compare the risks and benefits of autologous serum as an adjuvant therapy in macular hole surgery for stage 3 or 4 macular holes.Methods: Comparison of 2 consecutive (nonrandomized) cohorts using standardized methods for the determination of hole size and for surgical procedures, and using the same study surgeons. The serum cohort consisted of 106 eyes using autologous serum as an adjuvant, and the no serum cohort consisted of 58 eyes without adjuvants. The primary end point was the closure of the macular hole as determined by the 6-month fundus photographs. Secondary end points included the number and types of postoperative complications. Comparison in outcomes between the 2 cohorts used 2 and logistic regression procedures, adjusting for preoperative differences between the study cohorts.Results: At 6 months, the (unadjusted) rate of hole clo-sure was significantly greater for the eyes treated with serum than for the eyes not treated with serum (90 [85%] of 106 vs 40 [69%] of 58, P = .04). However, after adjusting for preoperative differences in hole diameter and the prevalence of epiretinal membranes, no overall difference in hole closure rates due to serum was found (P = .44). In contrast, benefit due to serum for large holes (diameter Ͼ573 µm) was seen (12 [75%] of 16 vs 13 [57%] of 23, P = .04). No differences in complication rates were found between the cohorts.Conclusions: Any beneficial effect of serum used as an adjuvant to macular hole surgery is small, and, if present, the beneficial effect may be limited to larger holes. A randomized, prospective, controlled study in larger macular holes is needed.

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Section: Commentmentioning

confidence: 99%

A Multicentered Clinical Study of Serum as Adjuvant Therapy for Surgical Treatment of Macular Holes

Banker¹

1999

Arch Ophthalmol

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“…Serum containing numerous growth factors can induce fibrocellular migration, adhesion, and proliferation. 23 Liggett et al 9 first used autologous serum as an adjuvant to increase the macular hole closure rate, and all 11 eyes (100%) had resolution of the surrounding subretinal fluid and flattening of the hole. Later, several case series also reported that autologous serum was beneficial in treating full-thickness macular holes and favorable in retreating eyes with previous failed macular hole surgery.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Autologous Serum on Vitrectomy with Internal Limiting Membrane Peeling for Idiopathic Macular Hole

Kung

2013

Journal of Ocular Pharmacology and Therapeutics

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Purpose: We sought to evaluate the effects of intraoperative adjunctive autologous serum in idiopathic fullthickness macular hole surgeries, and to compare the surgical outcomes with a no-serum control group. Methods: In this retrospective, case-control study, 38 consecutive eyes received vitrectomy with internal limiting membrane removal for idiopathic full-thickness macular holes. Two groups were created according to the use of autologous serum. Outcome measures were visual acuity (VA), closure of the macular hole confirmed by optical coherence tomography, and surgical complications. Results: Anatomical closure of the macular hole was achieved in 18 of 19 eyes (94.7%) in the vitrectomy with the autologous serum group, and in 18 of 19 eyes (94.7%) in the control group. The closure rates did not differ significantly between 2 groups (P = 1.000; the Fisher's exact test). At the final follow-up, the mean logMAR VA improved significantly in both groups (SD, standard deviation) [from 1.08 (0.21) to 0.47 (0.21) in vitrectomy with the serum group and from 1.01 (0.32) to 0.44 (0.30) in the control group (both P < 0.001; 2 tailed, paired t test)]. There was no significant difference between these 2 groups in terms of visual outcomes (P = 0.738; 2-tailed t test). There were no surgical complications, such as retinal detachment and endophthalmitis. Conclusions: The outcome of macular hole surgery did not differ both anatomically and functionally regardless of the use of adjuvant autologous serum. There seemed to be no additive effect with autologous serum.

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“…7 Since the first reports, a number of authors have reported their improved success rates with modification in surgical techniques including peeling of epiretinal membranes and the use of adjuvants. [2][3][4][5][6]9,10,14 It is also likely that success rates are modified by case selection.…”

Section: Discussionmentioning

confidence: 99%

“…1 In recent years, a number of authors have attributed increased success rate of surgery to the use of healing adjuvants (autologus serum, transforming growth factor ␤, platelets or thrombin), the initial stage and duration of macular hole. [2][3][4][5][6][7][8] The surgical technique common to the above studies necessitates postoperative facedown posturing in order to achieve effective tamponade of the macular hole. Indeed, there is evidence to suggest that longer duration of intraocular gas tamponade may have a favourable effect on the outcome of macular hole surgery.…”

Section: Introductionmentioning

confidence: 99%

Macular hole surgery with silicone oil

Kumar¹,

Banerjee²,

Loo³

et al. 2002

Eye

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Purpose Macular hole surgery usually involves gas tamponade which necessitates a variable period of postoperative posturing in a face-down position. A number of patients find this difficult or impossible for medical or social reasons. This study reviews our experience of macular hole surgery using silicone oil tamponade with no restriction of posturing. Methods Sixteen consecutive cases of macular hole (stage III/IV) surgery where silicone oil was used for tamponade were reviewed. Group A patients were unable for medical or social reasons to maintain a facedown posture and Group B patients had previous failed surgery with gas tamponade. Results Anatomical closure of hole was achieved in 81% (13/16) of all cases and 88% (7/8) of cases with no previous surgery (Group A) with a mean follow-up of 7.5 months (range 4-24 months). Mean visual improvement (log MAR value of visual acuity) for Group A and Group B were 0.41 and 0.03, respectively. Conclusions The success rate of macular hole surgery using silicone oil as tamponade, in cases with no previous surgery, is comparable to that achieved when gas is used as tamponade. Although good anatomical success can be achieved in cases with previous failed surgery, the visual outcome is less rewarding. Silicone oil is an alternative to gas tamponade for macular hole surgery in patients who are unable or unwilling to posture. However, it has to be borne in mind that silicone oil tamponade is not without risks.

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Treatment of Retinal Breaks with Autologous Serum in an Experimental Model

Cited by 3 publications

References 0 publications

A Multicentered Clinical Study of Serum as Adjuvant Therapy for Surgical Treatment of Macular Holes

A Multicentered Clinical Study of Serum as Adjuvant Therapy for Surgical Treatment of Macular Holes

The Effect of Autologous Serum on Vitrectomy with Internal Limiting Membrane Peeling for Idiopathic Macular Hole

Macular hole surgery with silicone oil

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