Effect of autologous platelet concentrate in surgery for idiopathic macular hole

Effects of autologous platelet concentrate and serum on retinal wound healing in an animal model

“…Clinical evidence would seem to accord with this finding, in that recent multicentre trials have demonstrated a significantly better anatomical outcome with the use of APC but not with AS [1,25]. In APC-treated eyes it may be that the presence of a platelet plug, acting as a 'depot', maintains a prolonged source of growth factor at the wound site, stimulating continuous migration and proliferation of cells.…”

“…Liggett used AS as a source of growth factors and demonstrated excellent macular hole closure rates associated with its use [19]; however, a subsequent multicentre study found no overall advantage [1]. In addition, there are a number of conflicting reports with regard to the benefit of APC, although a recent randomised multicentre trial has demonstrated a significantly better anatomical outcome associated with its use [25] Given this background, we undertook a histological and immunohistochemical study to investigate the effects of AS and APC on the healing response following full-thickness retinal incision and compared these with a control group. We found that a significantly greater proliferative response occurs during initial wound healing with the use of APC than with AS and in controls.…”

“…APC used during surgery may augment the reparative response by providing the mediators of the initial wound healing process. It must be acknowledged, however, that excellent anatomical and visual results are possible without use of adjuvants, particularly with stage II and early stage III holes [25]. It may be that surgery and manipulation of the hole, in particular ILM peeling, causes mechanical breakdown of the blood-ocular barrier, resulting in the initial inflammatory phase enabling platelet migration to the wound edges and growth factor release initiating the repair process.…”

“…Investigators have since used a number of other mitogenic agents, including mixtures of autologous plasma and thrombin [4], fibrin [16], Tussicol (Tussicol Duo 500, Immuno AG, Vienna) [31] and, more commonly, autologous serum (AS) [19,33] and autologous platelet concentrate (APC) [12]. We have reported a significantly better anatomical outcome with the use of APC [24], and a controlled trial has also reported beneficial effects of its use [25]. However, a controlled trial of TGFβ was negative [30], and there are recent reports of high success rates with other techniques, such as internal limiting membrane (ILM) peeling, where adjuvants are not used [21].…”

Determining the Effect of Preparation and Storage: An Effort to Streamline Platelet Components as a Source of Growth Factors for Clinical Application

“…These platelet preparations have been applied in diverse clinical fields. They have been used locally by ophthalmologists as an adjuvant to the ophthalmologic treatment of macular holes [10,11]; they have been used in cases of bone grafting showing to promote bone formation [12,13]; and they have proved effective in healing of chronic venous ulcers in cases of vascular surgery and dermatology [14,15]. Platelet concentrates has also been found to enhance healing of various kinds of wounds [16,17].…”