Abstract
PurposeTo evaluate the use of highly concentrated autologous platelet-rich plasma (PRP) in lamellar macular hole (LMH) surgery with regard to function and morphology.MethodsWe included 12 eyes of 12 patients with progressive LMH in this interventional case series. After 23/25-gauge pars plana vitrectomy, 0.1ml highly concentrated autologous platelet-rich plasma was applied under air tamponade. Induction of posterior vitreous detachment and peeling of tractive epiretinal membranes were performed whenever present. Phacovitrectomy was undertaken in cases of phakic lens status. Postoperatively, all patients were instructed to rest in a supine position for the first two postoperative hours. Best-corrected visual acuity (BCVA) testing, microperimetry, spectral-domain optical coherence tomography (SD-OCT), and fundus photography were carried out preoperatively and 6 months postoperatively.ResultsFoveal configuration was restored in 10 of 12 patients (83.3%) at 6 months postoperatively. Two patients who had not undergone ILM peeling showed a recurring defect at 6-month follow-up. Best-corrected visual acuity improved significantly from 0.29 ± 0.08 to 0.14 ± 0.13 logMAR (Wilcoxon: p=0.028). Microperimetry remained unchanged (23.38 ± 2.53 preoperatively; 23.0 ± 2.49 dB postoperatively; p=0.67). No patient experienced vision loss after surgery, and no significant intra- or postoperative complications occurred.ConclusionThe application of PRP in the surgical therapy of LMH results in good morphological and functional outcomes. Additional peeling of the ILM seems to be mandatory when using PRP to prevent the recurrence of LMH. Strict postoperative supine positioning for 2 h avoids PRP dislocation. Larger sample sizes are needed to confirm the results.
Highlights
Lamellar macular holes (LMHs) belong to a spectrum of progressive diseases at the retinal and vitreoretinal interface
Diagnosis of LMH is based on spectral-domain optical coherence tomography (SD-OCT), wherein three mandatory criteria must be visible: an irregular foveal contour, a foveal cavity with undermined edges, and a sign of foveal tissue loss
We show that the additional use of platelet-rich plasma (PRP) applied to the fovea after standardized vitrectomy and internal limiting membrane (ILM) peeling improves macular anatomy and retinal function
Summary
Lamellar macular holes (LMHs) belong to a spectrum of progressive diseases at the retinal and vitreoretinal interface. Not included in the current OCT classification of non-penetrating macular defects, degenerative and tractive LMH can be distinguished within the group of LMH These two LMH types show different behavior in terms of progression and surgical outcome [4]. Since the 1990s, platelet-rich plasma (PRP) has been described as an adjunct in the macular surgery of traumatic, persistent, and recurrent full-thickness macular holes or in optic disc pit maculopathy [6,7,8,9,10] This method has been used in vitreoretinal surgery, and in therapy for ocular surface diseases [11,12,13,14]. We present data from the 6-month follow-up [16]
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