Use of Autologous Platelets for Lamellar Macular Hole Repair

González, Andrés; Amin, Sarina; Iqbal, Omar; Potter, Stephen Myles; Khurshid, Syed Gibran

doi:10.1155/2019/1471754

Cited by 6 publications

(3 citation statements)

References 13 publications

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“…ERM and ILM peeling may lead to a FTMH, particularly in eyes with degenerative LMH with ERP [ 11 , 12 , 16 , 27 , 44 , 46 , 115 ]. Surgical modifications to improve the outcomes of degenerative LMH and to avoid iatrogenic FTMH, include the double inverted flap technique [ 125 ], ERP embedding into the retinal cleavage technique [ 126 ], ERP embedding combined with fovea sparing ILM peel [ 127 ], and highly concentrated autologous platelet-rich plasma with ILM peeling [ 128 , 129 ]. A recent small, randomized prospective study compared the outcomes of eyes with degenerative LMH and ERP that underwent PPV with foveal sparing ILM peeling and observation [ 124 ].…”

Section: Treatmentmentioning

confidence: 99%

Primary Lamellar Macular Holes: To Vit or Not to Vit

Bradshaw

2022

JCM

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There is a wide spectrum of macular conditions that are characterized by an irregular foveal contour caused by a break in the inner fovea. These include full-thickness macular hole (FTMH), foveal pseudocyst, lamellar macular hole (LMH) and macular pseudohole (MPH). Clinical examination of vitreomacular interface disorders is notoriously poor in differentiating these conditions. These conditions were initially described with slit-lamp biomicroscopy, and the main goal was to distinguish an FTMH from the others. The introduction of optical coherence tomography (OCT) has revolutionized our understanding of the foveal microstructural anatomy and has facilitated differentiating these conditions from an FTMH. However, the definitions of the other conditions, particularly LMH, has evolved over the past two decades. Initially the term LMH encompassed a wide spectrum of clinical conditions. As OCT became more widely used and observations became more refined, two different phenotypes of LMH became apparent, raising the question of different pathogenic mechanisms for each phenotype. Tractional and degenerative pathological mechanisms were proposed. Epiretinal membranes (ERMs) associated with each phenotype were identified. Typical ERMs were associated with a tractional mechanism, whereas an epiretinal proliferation was associated with a degenerative mechanism. Epiretinal proliferation represents Müller cell proliferation as a reactive process to retinal injury. These two types of ERM were differentiated by their characteristics on SD-OCT. The latest consensus definitions take into account this phenotypic differentiation and classifies these entities into LMH, MPH and ERM foveoschisis. The initial event in both ERM foveoschisis and LMH is a tractional event that disrupts the Müller cell cone in the foveola or the foveal walls. Depending on the extent of Müller cell disruption, either a LMH or an ERM foveoschisis may develop. Although surgical intervention for LMH remains controversial and no clear guidelines exist for pars plana vitrectomy (PPV), eyes with symptomatic, progressive ERM foveoschisis and LMH may benefit from surgical intervention.

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Section: Treatmentmentioning

confidence: 99%

Primary Lamellar Macular Holes: To Vit or Not to Vit

Bradshaw

2022

JCM

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“…In 2019, Gonzales et al published a small case series of three patients suffering from vitreoretinal interface diseases that were treated by vitrectomy without epiretinal membrane peeling with application of autologous platelet-rich plasma (PRP) [9]. The re-sults showed a promising restitution of foveal morphology and retinal function.…”

Section: Introductionmentioning

confidence: 99%

Highly Concentrated Autologous Platelet-Rich Plasma Restores Foveal Anatomy in Lamellar Macular Hole Surgery

Hagenau

Nobl

Vogt

et al. 2021

Klin Monbl Augenheilkd

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Background Lamellar macular holes (LMHs) are an entity of a progressive disease in which the efficacy of the therapy of choice, vitrectomy, seems to be reduced. It is unknown whether highly concentrated autologous platelet-rich plasma (PRP) is of value in the therapy of LMHs. The purpose of this study was to gauge the potential of highly concentrated PRP to restore foveal anatomy in LMH surgery. Patients and Methods In this interventional case series, eight eyes of eight patients with progressive LMH were included. All patients underwent a 23-gauge pars plana vitrectomy with induction of a posterior vitreous detachment and peeling of tractive epiretinal membranes whenever present. Under air tamponade, 0.1 mL of highly concentrated autologous PRP was applied. Subsequently, a gas or air tamponade was performed. All patients were instructed to rest in the supine position for the first 1 to 2 postoperative hours. Best-corrected visual acuity (BCVA) testing, microperimetry, spectral-domain optical coherence tomography (SD-OCT) and fundus photography were performed prior to and 3 months after surgery. Results SD-OCT showed closure of the macular defect with restoration of a normal foveal configuration in all (8 of 8) patients 3 months postoperatively. BCVA improved significantly, from 0.28 ± 0.08 to 0.12 ± 0.14 logMAR (Wilcoxon: p = 0.03). Microperimetry remained unchanged (24.13 ± 1.96 vs. 23.7 ± 1.54 dB; p = 0.46). No clinically significant intra- or postoperative complications were observed. Conclusion The use of highly concentrated PRP enables excellent anatomical and functional outcomes in the surgical therapy of LMH. Further prospective comparative trials are warranted to compare this promising technique with existing surgical strategies.

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“…9 As a result, in the last decade we have assisted to an exploding interest in the use of A-PRP in the treatment of FTMH and other similar macular surgical conditions. 9,[12][13][14][15][16] How A-PRP may facilitate FTMH healing it's still a matter of debate, but various trophic factors that are contained in platelets' granules, including platelet-derived growth factor (PDGF), transforming growth factor-β, basic fibroblast growth factor (b-FGF), vascular endothelial growth factor, epidermal growth factor (EGF) and angiopoietin-1 may promote tissue regeneration and modulate angiogenesis and inflammation. 9 Despite these advantages, the widespread diffusion of A-PRP as adjuvant in macular surgery is strongly limited by A-PRP preparation techniques.…”

Section: Introductionmentioning

confidence: 99%

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

Figueroa

Mora-Cantallops

Virgili

et al. 2020

European Journal of Ophthalmology

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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.

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Use of Autologous Platelets for Lamellar Macular Hole Repair

Cited by 6 publications

References 13 publications

Primary Lamellar Macular Holes: To Vit or Not to Vit

Primary Lamellar Macular Holes: To Vit or Not to Vit

Highly Concentrated Autologous Platelet-Rich Plasma Restores Foveal Anatomy in Lamellar Macular Hole Surgery

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

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