Vitrectomy and Concentrate of Autologous Thrombocytes in the Treatment ofIdiopathic Macular Holes

Overview

Objective:
To evaluate the results of surgery of idiopathic macular holes (IMH)using or not using autologous thrombocyte concentrates (ATC).Method: Fifty eyes with IMH, stage 2-4, were divided into two groups. Group 1comprised 27 eyes with an average persistence of complaints of 12 months wherepars plana vitrectomy (PPV) and tamponade with 16% C3F8 were combined withthe use of ATC. Group 2 comprised 23 eyes with a mean duration of complaints of14 months which were treated by PPV and 16%C3F8 without ATC. In all IMH stage2 and 3 the posterior vitreous membrane was detached from the retina. Theepimacular membrane was removed, if present. The mean follow-up period ingroup 1 was 17.2 months and in group 2 12.3 months.Results: In group 1 anatomical success was achieved in 21 eyes (78%), visual acuityimproved by two lines and more in 16 eyes (59%). In group 2 anatomical successwas recorded in 15 eyes (69%) (p=0.326) and visual acuity improved in 10 eyes (44%)(p=0.265). Nine eyes were reoperated with ATC. Reoperations improved the anatomical success in the whole series to 90% and the functional success to 62%.Thevisual acuity improved in 70% operated eyes within 12 months from the onset ofcomplaints and in 47% eyes with a longer case-history (p=0.1182). Complicationsincluded retinal tears in 5 eyes (10%), detachment of the retina in one eye (2%),minor facete-like defects in the pigmented epithelium in 22 eyes (44%), disciformmaculopathy in 5 eyes (10%) and atrophy of the optic disc in 3 eyes (6%).Conclusions: PPV is beneficial in IMH in the majority of patients. ATC can improveanatomical and functional results. Functional success is more likely after surgeryin the early stage of the disease. The results of surgery are jeopardized by variouscomplications. It is important to inform patients on the limitations and risk ofsurgery.

Key words:
idiopathic macular holes, pars plana vitrectomy, autologous throm-bocyte concentrates