Surgical management of macular holes: results using gas tamponade alone, or in combination with autologous platelet concentrate, or transforming growth factor beta 2

Abstract

Background-Vitrectomy and gas tamponade has become a recognised technique for the treatment of macular holes. In an attempt to improve the anatomic and visual success of the procedure, various adjunctive therapies-cytokines, serum, and platelets-have been employed. A consecutive series of 85 eyes which underwent macular hole surgery using gas tamponade alone, or gas tamponade with either the cytokine transforming growth factor 2 (TGF-2) or autologous platelet concentrate is reported. Methods-Twenty eyes had vitrectomy and 20% SF 6 gas tamponade; 15 had vitrectomy, 20% SF 6 gas, and TGF-2; 50 had vitrectomy, 16% C 3 F 8 gas tamponade, and 0.1 ml of autologous platelet concentrate prepared during the procedure. Results-Anatomic success occurred in 86% of eyes, with 96% of the platelet treated group achieving closure of the macular hole. Visual acuity improved by two lines or more in 65% of the SF 6 only group, 33% of those treated with TGF-2, and in 74% of the platelet treated group. In the platelet treated group 40% achieved 6/12 or better and 62% achieved 6/18 or better. The best visual results were obtained in stage 2 holes. Conclusion-Vitrectomy for macular holes is often of benefit and patients may recover good visual acuity, especially early in the disease process. The procedure has a number of serious complications, and the postoperative posturing requirement is diYcult. Patients need to be informed of such concerns before surgery.

Macular hole surgery with silicone oil

“…The initial anatomical closure rate of 88% for primary surgery (Group A) is comparable to those reported with gas tamponade for stage III / IV holes (58-91%). 1,3,7,14 The closure rate for repeat surgery was 75% in our series. Previously reported results of anatomical closure following reoperation with gas tamponade vary from 73-91%.…”

“…Previously reported results of anatomical closure following reoperation with gas tamponade vary from 73-91%. 3,5,15,16 The mean visual improvement (log MAR equivalent of visual acuity, Table 3) in Group A patients was 0.41. Snellen visual acuity improved by two lines or more in 63% (5/8) of cases in the same group.…”

“…This compares favourably with previously reported results for primary surgery with gas tamponade for stage III / IV macular holes (42-60%). 1,3,17 In cases with previous failed surgery (Group B) only 25% (2/8) of cases improved by two or more lines. Others have reported two or more lines of improvement in 25-75% of cases.…”

“…7 Since the first reports, a number of authors have reported their improved success rates with modification in surgical techniques including peeling of epiretinal membranes and the use of adjuvants. [2][3][4][5][6]9,10,14 It is also likely that success rates are modified by case selection.…”

“…1 In recent years, a number of authors have attributed increased success rate of surgery to the use of healing adjuvants (autologus serum, transforming growth factor ␤, platelets or thrombin), the initial stage and duration of macular hole. [2][3][4][5][6][7][8] The surgical technique common to the above studies necessitates postoperative facedown posturing in order to achieve effective tamponade of the macular hole. Indeed, there is evidence to suggest that longer duration of intraocular gas tamponade may have a favourable effect on the outcome of macular hole surgery.…”