Large Macular Holes Research Articles

Efficacy of Split-Thickness Thin Amniotic Membrane Graft for Closure of Refractory or Large Macular Holes.

To assess the effectiveness of split-thickness amniotic membrane (SAM) grafts in achieving closure of refractory or large macular holes (MH). This retrospective study reviewed data from patients who underwent surgical repair of MHs using SAM grafts between January 2019 and December 2023. Key parameters, including best-corrected visual acuity (BCVA) and MH size, were evaluated both preoperatively and postoperatively. The study included 13 patients (9 females; mean age 63.5 years). Before surgery, the median BCVA was 1.30 ± 0.56 LogMAR (approximate Snellen equivalent: 20/400), and the median MH size measured 717 ± 246.6 µm. After an average follow-up period of 28 months, the median BCVA improved significantly to 1.00 ± 0.52 LogMAR (p < 0.05) (approximate Snellen equivalent: 20/200). All MHs were successfully closed, and no intraoperative complications were observed. SAM grafting is a safe and reliable option for closing refractory or large MHs, resulting in significant improvements in BCVA and successful hole closure. Compared to full-thickness grafts, SAM grafts offer advantages such as increased flexibility in placement and ease of removal post-closure, due to their thinner and more pliable nature, which facilitates easier handling and positioning within the MH.

Anatomical and functional results of injectable plasma rich in growth factors as a treatment for poor prognosis macular holes

Aims/Purpose: The aim of this study is to analyse de benefits of plasma rich in growth factors (PRGF) as an adjuvant to pars plana vitrectomy (PPV) in por prognosis macular holes (MH).Methods: A retrospective descriptive study was performed in patients with MH. Large ( &gt; 400 μm), myopic, persistent and recurrent MH were included. Patients were treated with PPV associated with adjuvant injectable liquid PRGF. Postoperative best corrected visual acuity (BCVA) and the MH closure, by Optical Coherence Tomography (OCT), were evaluated. Other variables were analysed such as: sex, age, type of MH, diameter, base and height of the MH and type of closure by OCT.Results: A total of 12 eyes were included in the study, 10 female (83.3%) and 2 males (16.66%). The mean age was 64.83 ± 10.4 years. The MH presented diverse etiology: 4 were myopic MH (33.3%), 4 were persistent MH (33.3%) and 4 were idiopathic large MH. One of the myopic holes, was recurrent. 7 patients (58.3%) had large MH ( &gt; 400 microns). All patients underwent vitrectomy, internal limiting membrane (ILM) peeling and adjuvant PRGF. Complete closure of de MH was achieved in 11 patients (91.7%) and BCVA improvement in 9 patients (75%). Reconstitution of the external limiting membrane (ELM) and ellipsoid layer was observed in 5 patients (41.66%). In 5 patients (41.66%) closure type 1A was observed. Follow‐up time was 3 months. No adverse effects were recorded in any case.Conclusions: The use of PRGF as an adjuvant in PPV and ILM peeling in por prognosis MH may be an effective alternative to achieve anatomical closure of these, as well as reconstitution of the retinal structure and future improvement in final VA.

Chronology of spontaneous closure of a large traumatic macular hole with sub-macular haemorrhage

Chronology of spontaneous closure of a large traumatic macular hole with sub-macular haemorrhage

Anatomical outcome of temporal inverted flap technique versus conventional internal limiting membrane peeling for large macular hole treatment

ABSTRACT Objective To compare temporal inverted ILM flap (TIF) technique versus conventional ILM peeling (CILMP) technique in large idiopathic full-thickness macular hole (FTMH) regarding closure rate, and type of closure. Methods We conducted a randomized, interventional, prospective, comparative study. After informed consent, 40 eyes were included and were divided into 2 groups. Group 1 included 20 eyes that underwent Pars plana vitrectomy (PPV) with CILMP, and group 2 included 20 eyes that underwent PPV with the TIF technique in the period between December 2021 and July 2023. Pre and postoperative full ophthalmological assessment and OCT were done, with a follow-up period of 6 months after surgery. Results Macular hole (MH) closure was achieved in 80% of eyes in group 1 (16/20) and 90% of eyes in group 2 (18/20) after primary surgery. U-shaped foveal contour was achieved in 85%, 95%, and 100% of eyes in group 2 at 1,3 and 6 months respectively. However, it was recorded in 55% in group 1 at 1,3 and 6 months. Conclusion The MH closure rate achieved by the CILMP technique is comparable to that achieved by the TIF technique. However, the TIF technique achieves better foveal contour compared to the CILMP technique.

Analysis of the surgical treatment results of large idiopathic macular holes using tamponade with internal limiting membrane flaps and platelet-rich plasma

Analysis of the surgical treatment results of large idiopathic macular holes using tamponade with internal limiting membrane flaps and platelet-rich plasma

Macular Hole with an Intact Bacillary Layer.

To describe the clinical characteristics of macular holes (MH) with an intact bacillary layer. This retrospective study analyzed the characteristics and surgical results of 23 eyes with MH and an intact bacillary layer, with or without rhegmatogenous retinal detachment (RRD). Among the 23 eyes, 11 had only MH, and 12 had concurrent fovea-off RRD. Ten eyes (43.5%) were highly myopic. In the MH-only group, no bacillary layer detachment (BALAD) was observed before MH formation. Ten eyes underwent vitrectomy with internal limiting membrane (ILM) peeling and intravitreal injection of C3F8, and the other one received an intravitreal C3F8 only. The MH closure rate was 90.9% after one operation and 100% after two. In the RRD group, 66.7% had BALAD. ILM peeling was performed in 8 eyes (66.7%). The MH closure rate was 91.7% after one operation and 100% after two. Both groups showed significant visual improvement after surgery (P < 0.05). An intact bacillary layer can be observed in MH with or without concurrent fovea-off RRD. Surgical outcomes are similar to typical MH cases, and the intact bacillary layer may not facilitate MH sealing like the ILM. An ILM flap should be considered for large MHs or highly myopic eyes.

Yin-Yang Staining Technique to Create a Nonstained Internal Limiting Membrane Flap to Cover Large Idiopathic Macular Holes.

Purpose: To describe a modified technique for negative and positive (Yin-Yang) staining of the internal limiting membrane (ILM) to create a nonstained ILM flap that covers large idiopathic macular holes (MHs). Methods: Consecutive patients with large idiopathic MHs (>400 μm) were prospectively included in the study. After the central vitreous was removed, a droplet of triamcinolone acetonide was injected, covering the MH and surrounding area. Subsequently, indocyanine green (ICG) was injected to stain the outer area of the ILM, followed by creation of a flap from the temporal stained area. Finally, the nonstained ILM flap was inverted to cover the MH. The main outcomes included the best-corrected visual acuity (BCVA), macular contour, and integrity of the outer retina. Results: This study comprised 31 patients (31 eyes). Of the eyes, 28 (90.3%) achieved primary MH closure. The mean minimum linear diameter and base diameter of the MH was 593 ± 119 μm and 1082 ± 242 μm, respectively. At the 6-month follow-up, 12 eyes (38.7%) and 9 eyes (29.0%) had regained a U-shaped or V-shaped macular contour, respectively. In addition, the mean logMAR BCVA improved from 1.06 ± 0.30 preoperatively to 0.56 ± 0.31 (P < .001). Twenty-one eyes (67.7%) and 16 eyes (51.6%) had regained integrity of the external limiting membrane and ellipsoid zone, respectively, at the 6-month follow-up. Conclusions: The modified ILM staining technique using triamcinolone acetonide and ICG sequentially is a safe and effective method of creating a nonstained ILM flap that covers large MHs and prevents the foveal area from coming into direct contact with ICG.

A Non-Randomized Clinical Study on Temporal Inverted ILM Flap Versus ILM Peel in Macular Hole Larger Than 400 µm in size

Objective:To compare the efficacy of the temporal inverted ILM flap technique versus ILM peeling for better visual outcomes and closure of macular holes larger than 400 µm. Methodology: This was a non randomized controlled study conducted in the Department of Eye Unit 3, Institute of Ophthalmology, Mayo Hospital Lahore from January 2019 to December 2019. Twenty eyes with large macular holes were included; ten eyes were treated with the Temporal Inverted ILM Flap technique, and ten eyes were treated with ILM Peeling. Preoperatively all macular holes in both groups were assessed for visual acuity and size of macular hole on Optical Coherence Tomography (OCT). Postoperatively, one week, one month, three months, and six months, bestcorrected visual acuity (BCVA) was measured using the logarithm of the minimum angle of resolution (logMAR) scale and macular hole (MH) closure was assessed on OCT. The chi-square test was applied taking p-values &lt; 0.05 a significant. Results: Initially, both groups had an average BCVA of 0.54 ± 0.1 logMAR. After 6 months, the group that underwent Temporal Inverted ILM Flap surgery showed a notable enhancement in BCVA (0.30 ± 0.08 logMAR) in comparison to the group that underwent ILM Peeling surgery (0.40 ± 0.08 logMAR, p = 0.012). There was a higher rate of Type 1 closure (90% compared to 60%, p = 0.011) and better continuity of the ellipsoid zone (100% compared to 80%, p = 0.12) in the group that utilized the temporal inverted flap method as compared to simple ILM peel. Conclusion: Temporal Inverted ILM Flap approach is more effective than ILM peeling in terms of better visual acuity, higher type 1 closure rate, and better continuity of the ellipsoid zone. Keywords: ILM Peeling, Macular Hole, Retinal Surgery, Temporal Inverted ILM Flap, Visual Acuity

The inverted internal limiting membrane flap technique is not recommended for the treatment of large macular holes smaller than 650 µm.

To compare the anatomical and functional outcomes of the inverted flap technique versus conventional internal limited membrane (ILM) peeling in large idiopathic full-thickness macular holes (FTMHs) smaller than 650 µm. Retrospective comparative study. Patients with large idiopathic MHs smaller than 650 µm who underwent either the inverted flap technique (IFT) or ILM peeling were investigated. The main outcomes included the MH closure rate, recovery rates of the external limiting membrane (ELM) and ellipsoid zone (EZ) and best-corrected visual acuity (BCVA) at 1, 3, and 6 months postoperatively. Sixty-nine eyes of 69 patients who underwent the IFT (n = 32, group A) or ILM peeling (n = 37, group B) were included. In both groups, a significant BCVA improvement was acquired throughout the follow-up period. The mean BCVA increased at each follow-up visit in both groups (P<.001). However, the IFT group showed poorer visual results than the ILM peeling group at all time points (P=0.039, 0.005, 0.006). The ELM recovery rate in the ILM peeling group (78.3%, 29/37 eyes) was higher than that in the IFT group (53.1%, 17/32 eyes) at six months after surgery (p = 0.079). The IFT resulted in poorer ELM and visual recovery than ILM peeling, suggesting that the IFT is not a suitable option for repairing large MHs < 650 µm.

Autologous Neurosensory Retinal Flap Transplantation in a Porcine Model of Retinal Hole

PurposeAutologous retinal transplantation (ART) has been successfully employed in the treatment of large and myopic macular holes that are refractory to standard surgical treatments. Patients transplanted with a peripheral neurosensory retinal graft have shown unexpected improvements in visual acuity. The study aims to investigate if neural integration of the graft takes place in a porcine model of retinal hole. DesignExperimental animal study. SubjectsLeft eyes of ten Danish landrace pigs. MethodsThe pigs underwent vitrectomy under general anesthesia, and a subretinal bleb was created within the visual streak on both sites of the optic disc. A retinal hole, approximately 1900-4000 microns in size, was cut temporally using a vitrector. A graft of matching size was harvested from the nasal retina. The graft was gently moved toward the retinal hole under perfluoro-n-octane and placed within it. Endolaser was applied around the donor site, and either air or oil tamponade was used. Optical Coherence Tomography (OCT) and Color Fundus Photography were performed two and six weeks after surgery. At the end of follow-up, the eyes were enucleated for histological examination, including immunohistochemical analysis with antibodies against retinal glial cells, photoreceptors, and inner retinal neurons. ResultsRetinal hole closure was achieved in 9 out of 10 cases, with the graft remaining in situ in 6 cases. In 4 cases, OCT scans indicated preservation of the outer retinal layers, and in 2 of these cases, there was apparent integration with the adjacent host retina. Corresponding histology confirmed the preservation of the photoreceptor layer in 3 cases, but there was no evidence of graft integration with degeneration of the inner retina in all cases. The distance between the margins of the retinal hole decreased during follow-up, suggesting that the graft contracts and drags the surrounding retina towards the center. ConclusionThe outer retina of a retinal graft can be preserved, while the inner retina degenerates. No evidence of neuroretinal integration of the graft was observed. The retinal graft serves as a scaffold, promoting the centripetal migration of the edges of the hole, resulting in closure of large retinal holes.

Modified packing technique in large traumatic macular holes

Modified packing technique in large traumatic macular holes

Macular holes with minimal diameter greater than 650 µm close in 85% of cases after vitrectomy and ILM peeling with visual benefit.

To describe the postoperative outcomes of eyes with primary full-thickness macular holes (MH) greater than 650 μm. Retrospective, monocentric, consecutive case series. Patients with primary MH operated at Lariboisière Hospital, Paris, France. Records of patients with MH with a minimum horizontal diameter greater than 650 μm that underwent primary surgery with internal limiting membrane (ILM) peeling (complete or with inverted ILM flap) between January 2010 and January 2022 were reviewed. Postoperative MH closure rate and visual acuity. 74 eyes of 73 patients met the inclusion criteria. The mean minimum horizontal diameterwas 777 ± 108 µm (650-1114). It ranged between 650 and 800 µm in 40 eyes (54%) and was ≧ 800 µm in 34 eyes (46%). The closure rate was 77% (57/74) after primary surgery and was significantly higher in MH between 650 and 800 µm, than in MH ≧ 800 µm (87.5% versus 64.7%, p = 0.02). In the 58/74 eyes in which conventional ILM peeling was performed, closure rate was 74.1% (43/58), significantly higher in MH ranging between 650 and 800 µm than in MH ≧ 800 µm (84.8% versus 60.0%, p = 0.03). In closed MH, 50/64 (78%) eyes achieved a VA gain ≥0.2 logMAR (3 lines), and 14 (21.9%) eyes a final BCVA ≥ 0.3 logMAR. MH surgery with conventional ILM peeling allowed closed MH ≧ 650 μm and < 800 μm with a success rate close to 85% that decreased in larger MH. A significant visual improvement was achieved after MH closure, even in MH ≧ 800 μm.

PEDICLE TRANSPOSITION FLAP, INVERTED FLAP, FREE FLAP, AND STANDARD PEEL FOR LARGE FULL-THICKNESS MACULAR HOLES: A Comparative Study.

To compare anatomical and functional outcomes of four different techniques for the treatment of large idiopathic full-thickness macular holes. This single-center retrospective study included 129 eyes of 126 patients with large (>500 µ m) full-thickness macular holes who presented between January 2018 and October 2022. All patients underwent 23/25 G vitrectomy and gas with standard internal limiting membrane (ILM) peel, pedicle transposition, inverted, or free flap technique. Postoperative optical coherence tomography images were assessed by two independent masked graders. Mean age was 73.2 years (SD 8.4) with a median F/U of 5 months (IQR 8). The overall anatomical success rate was 81%; it was significantly lower (59%) for the standard ILM peel ( P < 0.0001). The pedicle transposition flap showed superior visual recovery compared with the free flap (+27 vs. +12 ETDRS letters, P = 0.02). At 3 months, restoration of the external limiting membrane was significantly better for the pedicle transposition flap compared with free flap and standard ILM peel ( P = 0.008 and P = 0.03) and superior to all the other techniques at 6 months ( P = 0.02, P = 0.04, and P = 0.006). Standard ILM peel alone offers inferior outcomes for the management of large full-thickness macular holes. Of the alternative ILM techniques, despite similar closure rates, foveal microstructural recovery is most complete following the pedicle transposition flap and least complete following the free flap.

Medical Therapy for Large Idiopathic Full-Thickness Macular Holes.

To describe the characteristics and outcomes of eyes with idiopathic full-thickness macular holes (FTMH) that underwent initial medical management. This retrospective study included eyes with FTMH that were initially managed with one month of topical therapy. Eligible subjects were treated with dorzolamide 2% three times a day, nepafenac 0.1% twice a day, and prednisolone acetate 1% four times a day. The primary endpoints was hole closure at one month and secondary endpoint was change in best-corrected visual acuity (BCVA). Ten subjects (mean age: 62.80 years; female: 50%) with unilateral FTMH were studied. The mean basal diameter of the entire cohort at baseline was 824.1 µm (median 828 µm). Four (40%) of the smaller holes (mean 698 µm; median 698.50 µm) closed after one month of topical therapy, whereas larger holes (mean 908.17µm; median 889.50 µm) did not close. In one eye, the hole reopened 4 months after stopping the medication, but closed again at one month after re-starting the topical treatment. Median BCVA improved from 0.35 logMAR at baseline to 0.05 logMAR in eyes that closed but remained at 0.70 logMAR at one month in eyes that did not close. Topical corticosteroid, non-steroidal anti-inflammatory, and carbonic anhydrase inhibitor therapy may promote closure of small FTMHs, but large holes are less likely to respond. One month of topical therapy might avoid subjecting some patients to complex vitreo-retinal surgery without compromising visual outcomes. Macular hole may re-open after stopping the topical therapy.

Internal Limiting Membrane Peeling for Large Macular Holes Induces Only Structural Remodeling without Functional Impairment Over 12 Years

To evaluate the very long-term functional and structural outcomes of internal limiting membrane (ILM) peeling for full-thickness macular holes (FTMH). Observational case series nested within a multicenter, randomized, controlled clinical trial (RCT) (ClinicalTrials.gov: NCT00190190). Patients who underwent vitrectomy with or without ILM peeling for an idiopathic large FTMH in a tertiary ophthalmology center, with a minimum follow-up of 10 years after surgery. Review of charts, spectral-domain OCT (SD-OCT) scans, OCT angiography (OCTA) scans, and microperimetry of patients originally enrolled in the RCT. Primary outcome was functional assessment in both groups (ILM peeling or not) including the retinal sensitivity (RS), distance and near best-corrected visual acuity (BCVA), and number of eyes achieving ≥0.3 logarithm of the minimum angle of resolution >10 years after surgery. Secondary outcomes were structural assessment in the entire 3× 3-mm and 6× 6-mm areas, and regionally in the different areas of the ETDRS grid: OCT and OCTA biomarkers in both groups and fellow eyes. Thirteen eyes of 13 patients with a mean follow-up of 12 ± 0.73 years were included. The mean RS and BCVA, or visual improvement did not differ between ILM peeling (n= 8) and no peeling (n= 5) (all P > 0.05). The dissociated optic nerve fiber layers on en face OCT were only observed in eyes with ILM peeling, predominantly in temporal parafoveal (20%) and perifoveal (19%) rings. The mean total retinal thickness and inner retinal thickness in the parafoveal ring were significantly lower in peeled eyes (309 ± 11 μm and 94 ± 9 μm respectively) versus nonpeeled eyes (330 ± 21 μm and 108 ± 11 μm respectively; P= 0.037 and P= 0.040), without significant difference in ganglion cell or retinal nerve fiber layers. Accordingly, the mean superficial capillary plexus density in the parafoveal ring was significantly lower in eyes with peeling versus without (39.65 ± 3.76 % versus 47.22 ± 4.00; P= 0.005). The mean foveal avascular zone area was smaller in eyes with peeling versus without (0.24 ± 0.05 mm2 vs. 0.42 ± 0.13 mm2, respectively, P= 0.005). Despite persistent structural changes especially in the parafoveal ring, ILM peeling for idiopathic large FTMH did not seem to impact long-term RS or BCVA over 12 years. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Intraoperative closure of large full thickness macular holes with perfluorocarbon liquid.

To report the role of perfluorocarbon liquid (PFCL) and passive extrusion for management of large full thickness macular holes (FTMHs). A standard pars plana vitrectomy with induction of posterior vitreous detachment was performed for all patients. After internal limiting membrane (ILM) peel, a bubble of perfluorocarbon liquid (PFCL) was injected over the posterior pole and passive extrusion of fluid was performed with a backflush instrument below the PFCL bubble, without touching the FTMH edges, until the FTMH centre was reached. Intraoperative optical coherence tomography (OCT) showed formation of an inner retina roof in all cases and confirmed intraoperative FTMH closure. Complete PFCL removal was performed after fluid-air exchange and gas tamponade was utilised in all cases. Preoperative FTMH mean aperture size was 761um and standard deviation (SD) 100um (range 682-918um). FTMH closure was achieved in all eyes and visualised intraoperatively with OCT. After an average follow-up of 2 months, there was improvement in the mean BCVA and central scotoma. FTMH closure can be achieved intraoperatively with the use of PFCL and passive extrusion. The described surgical technique could be a valid alternative for repair of large FTMHs.

Modified ILM flap techniques versus classical inverted ILM flap technique for large macular holes: a systematic review and meta-analysis of randomized controlled trials

BackgroundMacular holes (MHs) constitute a vitreoretinal interface disorder that occurs when structural abnormalities in the fovea lead to impaired central vision. The standard treatment for MHs is mainly surgical. Using an inverted internal limiting membrane (ILM) flap has enhanced the success rates of MH surgeries. This systematic review and meta-analysis aimed to compare the classical inverted ILM flap technique to modified ILM flap techniques for managing large MHs.MethodsWe searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the classic inverted ILM flap technique to modified ILM flap techniques as initial surgical treatment of eyes with large MHs of more than 400 microns. We sought to evaluate the following outcomes: (1) MH closure. (2) Best-corrected visual acuity (BCVA). (3) Foveal closure type (4) Rate of ellipsoid zone (EZ) defects and external limiting membrane (ELM) defects. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcomes.ResultsFour RCTs that enrolled 220 participants were deemed eligible. The analysis revealed no statistically significant differences in MH closure between both groups (95% CI: 0.20, 7.96; P = 0.81). No statistically significant differences in mean BCVA were found at 1 and 3 months between both groups (SMD: 0.04; 95% CI: −0.16, 0.23; P = 0.70 and SMD: −0.167; 95%CI: −1.240, 0.906; P = 0.760, respectively). In addition, there were no significant differences between the two groups in the pattern of foveal closure, namely U-shape, V-shape, and flap open at 3, 6, and 12 months (RR: 0.87; 95% CI: 0.67, 1.12; P = 0.28, RR: 0.96; 95% CI: 0.58, 1.61; P = 0.89, and RR: 1.95, 95% CI: 0.26, 14.50; P = 0.51, respectively). Finally, the analysis showed no statistically significant difference in both groups’ EZ and ELM defect rates at 3, 6, and 12 months (RR: 1; 95% CI: 0.85; 1.18: P = 1 and RR: 1.14; 95% CI: 0.90, 1.45; P = 0.27).ConclusionMacular holes (MHs) constitute a vitreoretinal interface disorder that occurs when structural abnormalities in the fovea lead to impaired central vision. The standard treatment for MHs is mainly surgical. Using an inverted internal limiting membrane (ILM) flap has enhanced the success rates of MH surgeries. This systematic review and meta-analysis aimed to compare the classical inverted ILM flap technique to modified ILM flap techniques for managing large MHs.

MANAGEMENT OF LARGE FULL-THICKNESS MACULAR HOLES: Long-Term Outcomes of Internal Limiting Membrane Flaps and Internal Limiting Membrane Peels.

To determine and compare the efficacy of a surgical internal limiting membrane (ILM) flap technique with the traditional ILM peel on long-term visual and anatomical outcomes for large (>400 µm) full-thickness macular holes. From October 2016 to July 2022, patients undergoing initial full-thickness macular hole repair with the ILM flap or ILM peel technique were reviewed. Final outcomes were recorded and based on size in microns: 401 to 800, 801 to 1,200, and >1,200. Patients treated with ILM flap (n = 52, 94.2% closure rate) or ILM peel (n = 407, 93.6% closure rate) were followed with a mean follow-up time of 15.0 ± 10.2 and 20.0 ± 13.4 months, respectively. Success rates for ILM flaps and ILM peels were compared for full-thickness macular holes of 401 to 800 (100%, 95.8%, P = 0.39), 801 to 1,200 (95%, 93%, P = 0.74), and >1,200 (86.7%, 86.7%, P = 1.0) µm. Mean best-recorded logarithm of the minimal angle of resolution visual acuity for ILM flaps and ILM peels, respectively, was 1.02 ± 0.46 and 0.87 ± 0.47 preoperatively, with follow-up acuity of 0.48 ± 0.32 (P < 0.03) and 0.39 ± 0.42 (P < 0.01) at Year 3. Both techniques provide a similar anatomical closure rate and functional improvement in vision. Comparisons should be cautiously made based on difference in preoperative hole size.

Clinical evidence of autologous platelet-rich plasma as treatment in macular holes

Abstract Background: A prospective observational study was conducted with the purpose of evaluating the role of autologous platelet-rich plasma (PRP) in the form of a clot as an adjunct in surgery for the closure of large full-thickness macular holes (&gt;400 μm). Methodology: Thirteen patients with a diagnosis of full-thickness macular hole larger than 400 μm, without associated pathologies or previous vitreoretinal surgeries, were selected. Each patient underwent a complete ophthalmological evaluation, including visual acuity (uncorrected or best corrected), optical coherence tomography (OCT Optovue), and in some cases, retinal photographs. On the day of the procedure, blood samples were taken to prepare PRP and form a clot according to institutional protocol. Patients were followed for 1 year with periodic evaluations that included OCT, retinal photographs, and assessments by a retina specialist and optometry. Results: Of the 13 patients, 46% (6 cases) had an epiretinal membrane as the triggering factor for the macular hole and 54% (7 cases) had vitreomacular traction. Complete closure of the macular hole was achieved in 92.31% (12 cases) and partial closure in 7.69% (1 case). Postoperative best-corrected visual acuity ranged from 20/30 to 20/200 according to the Snellen chart. No patient experienced a deterioration in visual acuity after the procedure. Conclusions: The use of PRP as an adjunct treatment for macular hole surgery in patients without previous vitreoretinal surgeries has proven to be effective in achieving complete or partial closure in a high percentage of cases. Pre-and postoperative changes in visual acuity, hole size, and type of closure provide valuable information on the efficacy of PRP treatment in these patients.

A NOVEL SURGICAL TECHNIQUE FOR GIANT AND REFRACTORY MACULAR HOLES: AUTOLOGOUS TENON CAPSULE PLUG.

To evaluate the safety and efficiency of the autologous Tenon capsule plug (ATCP) technique for the treatment of large (1000 um<) and refractory macular holes (MHs). This retrospective, interventional, case series included 3 patients who underwent 23-gauge vitrectomy and ATCP technique for giant or refractory MH. All patients underwent a complete ophthalmic examination including optical coherence tomography (OCT), OCT angiography (OCTA), and microperimetry (MP). The changes in retinal structure and function were evaluated. The minimum follow-up was 6 months. The preoperative minimum hole diameters were 728 um, 422 um, and 1154 um for case 1, case 2, and case 3 respectively. Case 1 and case 2 had an idiopathic MH that failed to close after vitrectomy with (internal limiting membrane) ILM peeling, whereas case 3, who had a giant, irregular MH underwent the ATCP technique as the primary intervention. Complete hole closure was achieved in all patients at the last follow-up. However, case 1 required a second ATCP surgery due to dislodgement of the plug in the early postoperative period. The BCVA increased in all patients. The final MP analysis revealed that the percentage of fixation points at circles 4o for case 1, case 2 and case 3 were 93.5%, 99.9% and 95.6% respectively. We suggest that the ATCP technique can provide a simple, cheap, repeatable, and readily available surgical solution for the treatment of giant and refractory macular holes. Further prospective studies with a larger sample size are needed to confirm our preliminary results.