Autologous platelet concentrate in surgery for macular detachment associated with congenital optic disc pit

Abstract

PurposeTo evaluate the anatomical and functional results obtained with pars plana vitrectomy (PPV) plus autologous platelet concentrate (APC) as a treatment for macular detachment associated with optic disc pit (ODP).MethodsWe performed a prospective interventional study of 19 eyes of 19 consecutive patients with posterior macular detachment due to ODP. All patients underwent PPV, posterior hyaloid peeling, fluid–air exchange, injection of 0.05 mL of APC over the ODP and 15% perfluoropropane (C3F8) endotamponade. Postoperative measures included face-up positioning for 2 hours and then avoidance of the face-up position during the ensuing 10 days. All patients underwent complete ophthalmologic examination and optical coherence tomography preoperatively at 1 month, 3 months, 6 months, 9 months, and 12 months postoperatively and then annually. Outcome measures were best corrected visual acuity (BCVA) by logMAR, improvement of quality of vision, macular attachment, and resolution of intraretinal schisis-like separation.ResultsPreoperatively, the median BCVA was 0.70 (range: 0.30–1.70) and all patients showed improved visual acuity after surgery; BCVA was 0.22 (range: 0.07–0.52) at 12 months follow-up. All patients showed complete reabsorption of intraretinal fluid (median time: 3.5 months [range: 2–8 months]) and macular attachment at the end of follow-up (median: 60 months [range: 12–144 months]), with stable or improved visual acuity. No reoperations were needed and no major adverse events were recorded.ConclusionFor macular detachment associated with ODP, the combination of PPV, posterior hyaloid peeling, APC, and C3F8 tamponade is a highly effective alternative technique with stable anatomical and functional results.

Efficacy of Internal Limiting Membrane Flap Techniques with Vitrectomy for Macular Detachment Associated with an Optic Disc Pit

“…Also, of the patients with attached macula, 80% required more than 180 days for reattachment to occur. This is in keeping with previous studies that showed that improvement of vision is related to restoration of the normal retinal morphology [10-14, 19, 21, 22, 25-31]. This becomes progressively more evident 6–12 months postoperatively, as submacular fluid is slow to resolve (Table 3).…”

“…Improvement of vision was achieved in 89% of our cases, with a mean visual gain of almost 3 lines on the Snellen chart at the end of the follow-up time, and 67% had a final BCVA of 0.5 or better. This compares favourably with other functional results [10-14, 19, 22, 25-31]. Similar functional outcomes have been reported by D’Souza et al [16] and Nawrocki et al [17] using the same surgical procedure.…”

“…Certainly, the best clinical evidence to determine which treatment is superior in patients with ODP maculopathy would be obtained through a randomized clinical trial of different adjuvant surgical procedures to PPV [10, 11, 13, 14, 18, 22, 25, 28-30]. However, it is unlikely that such a trial can be performed for this very rare clinical entity.…”

“…Currently, the most widely accepted treatment for this condition is pars plana vitrectomy (PPV). The necessity of adjuvant surgical procedures such as temporal ODP endolaser photocoagulation [10-13], autologous platelet concentrate [14] and many others remains unclear. Nevertheless, interventions for the treatment of ODP maculopathy are valuable, as they may prevent significant visual loss in these patients.…”

Platelet Lysate Inhibits NF-κB Activation and Induces Proliferation and an Alert State in Quiescent Human Umbilical Vein Endothelial Cells Retaining Their Differentiation Capability

“…Therefore, they could be used as a powerful therapeutic tool to trigger and enhance the healing process. Encouraging results were already achieved by the use of different platelet by-products in dental and maxillofacial surgery [5], in orthopedics [6,7], and in ophthalmology [8,9]. Clinical trials, demonstrating beneficial effects for the treatment of degenerative cartilage diseases, were conducted with platelet-rich plasma (PRP) [10] and also with autologous platelet lysate (PL) [11].…”