Хирургическое лечение дегенеративного ламеллярного макулярного разрыва с применением богатой тромбоцитами плазмы крови

Abstract

Introduction. Surgical treatment of patients with degenerative lamellar macular hole (LMH) does not always improve visual acuity. One of the risk factors for such results is pronounced thinning of the retina in the area of the hole. In such cases, it was suggested to supplement the standard surgical technique with the application of autologous platelet-rich blood plasma (PRP) to the area of the hole. Purpose. To present a clinical case of surgical treatment of degenerative LMH with pronounced retinal thinning using PRP. Material and methods. Patient C., 68 years old, complained of distortion of objects contours and decreased vision in the right eye. His corrected visual acuity was 0.4. Optical coherence tomography revealed a degenerative LMH (Govetto A. et al. classification, 2016) of the right eye with significant retinal tissue defect, with ellipsoidal photoreceptor zone defect and minimal retinal thickness of 59 μm. A three-port subtotal 27G vitrectomy was performed with removal of the epiretinal membranes and internal limiting membrane, tamponade of the vitreal cavity with air, and application of autologous PRP to the hole area. Results. The dynamics of retinal recovery in terms of up to 9 months after surgery is described, the minimum retinal thickness increased from 59 to 238 μm; the maximum corrected visual acuity increased from 0.4 to 1.0. The formation of a hyperreflective zone similar in optical density to plexiform layers was noted in the area where the hole had previously occurred. The size of the hyperreflective zone decreased during observation. By 9 months after surgery, the ellipsoidal zone defect was virtually undetectable. Conclusion. The use of PRP resulted in not only closure of the hole but also normal retinal thickness in the foveal area which contributed to the restoration of the ellipsoidal zone of the photoreceptors and a significant increase of visual acuity. Presumably, PRP contributes to the speedy closure of the hole due to the formation of a glial scar of minimal size. Key words: degenerative lamellar macular hole, platelet-rich blood plasma, vitrectomy, hyperreflective zone, glial scar