Therapeutic Efficacy of Autologous Platelet Concentrate Injection on Macular Holes with High Myopia, Large Macular Holes, or Recurrent Macular Holes: A Multicenter Randomized Controlled Trial

Abstract

We aimed to evaluate the anatomical and functional outcomes of pars-plana vitrectomy (PPV) with or without autologous platelet concentrate (APC) injection in patients with recurrent macular holes (MHs), large MHs, or MHs with high myopia. This multicenter, prospective, interventional randomized controlled trial was conducted from March 2017 to April 2020. Participants were randomly allocated to a PPV group or a PPV+APC group. All participants underwent standard 25-gauge PPV, and eyes in the PPV+APC group underwent PPV with intravitreal APC injection before air-gas exchange. A total of 117 patients were enrolled (PPV group: n = 59, PPV+APC group: n = 58). Hole closure was achieved in 47 participants (79.7%) in the PPV group and 52 participants (89.7%) in the PPV+APC group. There were no between-group differences in the anatomical closure rate or functional outcomes including best-corrected visual acuity, metamorphopsia, pattern-reversal visual evoked potential, or Visual Function Questionnaire-25 score. The use of APC injection does not improve the anatomical and functional outcomes of surgery for large MHs, recurrent MHs, or MHs with high myopia. The adjunctive use of APC can be considered in selected cases because it is not inferior to conventional MH surgery, is relatively simple to perform, and is not affected by the surgeon’s skill.

Therapeutic Effect of Using Autologous Platelet Concentrate in Vitrectomy for Macular Hole: A Systematic Review and Meta-analysis

“…More studies are needed to be conducted to provide sufficient results. Second, the included studies had a few inconsistencies, e.g., some studies 6,14 combined cataract surgery in vitrectomy in both treatment and control groups; Kim et al 6 used an inverted ILM flap technique as needed in a significant number of patients in both groups to improve the success rate of the surgery, which may influence the pooled results. Although subgroup analysis showed no significant deviations in subtypes of RCT and other studies, the gauge of vitrectomy, the tamponade materials, the type of MH, whether OCT assessment was used, and the risk of bias, other potential biases which was not reported by some of the studies still need to be considered.…”

“…A total of seven studies [5][6][7][11][12][13][14] (634 eyes) met the inclusion criteria and were included in the metaanalysis. Figure 1 shows the detailed study selection process, and Table 1 describes the baseline information of the included studies.…”

“…Figure 1 shows the detailed study selection process, and Table 1 describes the baseline information of the included studies. Three studies 6,7,13 were randomized controlled trials (RCTs), two studies 11,12 were prospective non-RCTs, and two studies 5,14 were retrospective controlled studies. Literature quality evaluation revealed different risks of bias among the studies (see Supplemental Digital Content 2, http:// links.lww.com/IAE/C40).…”

“…5,7 However, some studies reported negative findings. 6,8 Besides, owing to the complex process of preparing APC, the safety of using APC is also controversial. Therefore, choosing APC as an adjuvant for vitrectomy surgery is difficult for clinicians.…”

“…In recent years, many studies have reported the use of autologous platelet concentrate (APC) as adjunctive agents in MH vitrectomy. 5–7 These studies suggest that the anticoagulant components and growth factors in APC can stimulate fibrosis and the proliferation of fibrocytes and glial cells, promoting the closure of MHs. Compared with the control group, the closure rate of MH and postoperative visual acuity (VA) were reported to be improved to various extents.…”