Chronic Traumatic Giant Macular Hole Repair with Autologous Platelets

Abstract

We report on the closure of a chronic posttraumatic giant macular hole. The patient presented with decreased vision in the left eye following blunt trauma 20 years prior. His dilated fundus examination revealed a 3000 um base-diameter full thickness macular hole. Surgical repair was performed with pars plana vitrectomy (PPV), internal limiting membrane peeling and autologous platelet concentrate (APC) injected over the macular hole. At one month follow-up, the macular hole had closed on exam and optical coherence tomography (OCT), and the patient reported subjective visual improvement. To our knowledge, this report presents the first case of a chronic giant macular hole successfully closed after undergoing surgery with adjuvant platelets therapy.

Combined Internal Limiting Membrane Flap and Autologous Plasma Concentrate to Close a Large Traumatic Macular Hole in a Pediatric Patient

“…4 A prior report of the use of APC was reported by Wachtlin et al in four pediatric patients with macular hole though these holes were around 300 μm in size. 15,16 Our technique combined these two methods: we believe this technique is particularly advantageous for pediatric patients with a large macular hole as the APC with the ILM flap provide a strong plug and a scaffold for cell proliferation to seal the hole and allow for anatomical closure. Intraoperative OCT was particularly helpful in this case in confirmation of the location of the ILM flap as well as the placement of the APC.…”

Vitrectomy vs. Spontaneous Closure for Traumatic Macular Hole: A Systematic Review and Meta-Analysis

“…Therefore, vitrectomy with membrane peeling might be helpful and is a standard surgical procedure for treating TMH ( 6 ). Currently, PPV, ILM peeling or flap, and intraocular gas or silicone oil tamponade are the most commonly employed surgical procedures for TMH treatment ( 5 ). Ghoraba et al concluded that gas tamponade is more successful than silicone oil tamponade for the anatomical closure and VA improvement of TMH ( 30 ).…”

“…Currently, surgical techniques include removing the posterior vitreous cortex and epiretinal membranes, with or without internal limiting membrane (ILM) peeling, and intraocular gas or silicone oil tamponade. Various adjuvant therapies, including transforming growth factor-beta (TGF-β), biological tissue adhesives, and platelet concentrate, have been investigated with varying degrees of success ( 5 , 6 ). However, there are many unanswered questions about the necessity of surgery because spontaneous hole closure has been commonly reported ( 7 ).…”

Comparison of platelet-rich plasma and inverted internal limiting membrane flap for the management of large macular holes: A pilot study

“…[ 22 33 ] Coca et al .reported successful anatomical closure of a single chronic traumatic MH with BD of 3000 μm. [ 34 ] However, most of the reports are either single-arm non-comparative studies or include small MHs. The efficiency of platelets for large macula holes is limited to mere case reports.…”