The Effect of Autologous Serum on Vitrectomy with Internal Limiting Membrane Peeling for Idiopathic Macular Hole

Abstract

Purpose: We sought to evaluate the effects of intraoperative adjunctive autologous serum in idiopathic fullthickness macular hole surgeries, and to compare the surgical outcomes with a no-serum control group. Methods: In this retrospective, case-control study, 38 consecutive eyes received vitrectomy with internal limiting membrane removal for idiopathic full-thickness macular holes. Two groups were created according to the use of autologous serum. Outcome measures were visual acuity (VA), closure of the macular hole confirmed by optical coherence tomography, and surgical complications. Results: Anatomical closure of the macular hole was achieved in 18 of 19 eyes (94.7%) in the vitrectomy with the autologous serum group, and in 18 of 19 eyes (94.7%) in the control group. The closure rates did not differ significantly between 2 groups (P = 1.000; the Fisher's exact test). At the final follow-up, the mean logMAR VA improved significantly in both groups (SD, standard deviation) [from 1.08 (0.21) to 0.47 (0.21) in vitrectomy with the serum group and from 1.01 (0.32) to 0.44 (0.30) in the control group (both P < 0.001; 2 tailed, paired t test)]. There was no significant difference between these 2 groups in terms of visual outcomes (P = 0.738; 2-tailed t test). There were no surgical complications, such as retinal detachment and endophthalmitis. Conclusions: The outcome of macular hole surgery did not differ both anatomically and functionally regardless of the use of adjuvant autologous serum. There seemed to be no additive effect with autologous serum.

Autologous anterior lens capsule flap and serum transplant in managing idiopathic and refractory full-thickness macular holes

“…LCFT provided similar outcomes to ILM transplant 17 and inverted flap techniques, 3,18 being useful in long-lasting cases where a greater ILM rigidity might be observed. 19 From our results, the use of LCFT and autologous serum were effective in both idiopathic and refractory 20 Furthermore, it creates a bridge for proliferation of glial cells that fill the hole. Nowadays, in almost all operating rooms, all the components needed for this combined treatment are easily available, LCF is more robust and easier to harvest en-bloc than an ILM flap and other proposed tissues.…”

“…Moreover, the autologous serum contains numerous growth factors that can induce fibrocellular migration, adhesion, and proliferation. 20 Furthermore, it creates a bridge for proliferation of glial cells that fill the hole.…”

Swept Source-Optical Coherence Tomography-Guided Facedown Posturing to Minimize Treatment Burden and Maximize Outcome after Macular Hole Surgery

“…After Kelly and Wendel first described the treatment for full-thickness MHs [ 1 ], surgeons have attempted to further enhance patient outcomes and closure rates by implementing and attempting various modifications to the technique for repair [ 2 , 3 , 4 , 5 , 6 ]. With the modifications of the surgical technique, such as ILM peeling [ 2 , 3 , 4 ], inverted ILM flaps [ 5 , 6 ], autologous serum use [ 32 ], amniotic membrane [ 33 ], and retinal grafts [ 34 ], MH has become a treatable disease with a high anatomical success rate reaching more than 90% [ 7 , 8 ]. Despite these improvements, there is continued debate over whether postoperative posturing is necessary.…”

Current Trends in Macular Hole Repair

“…Comparative studies have been scarce. Recent retrospective studies have found no added benefit of autologous serum to the standard ILM peel [125] and significantly higher rate of MH closure with APC compared to WBC [126]. Finally, APC has also been described in combination with a new technique called ''inversion of the hole margin'' in which glial tissue at the MH margin was scraped centrally, followed by a plug of APC.…”