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 beta 2 (TGF-beta 2) or autologous platelet concentrate is reported.

METHODS:

Twenty eyes had vitrectomy and 20% SF6 gas tamponade; 15 had vitrectomy, 20% SF6 gas, and TGF-beta 2; 50 had vitrectomy, 16% C3F8 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 SF6 only group, 33% of those treated with TGF-beta 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 difficult. Patients need to be informed of such concerns before surgery.

• Authors: M Minihan, M Goggin, P E Cleary
• Journal: The British journal of ophthalmology (Br J Ophthalmol) Vol. 81 Issue 12 Pg. 1073-9 (Dec 1997) ISSN: 0007-1161 [Print] England
• PMID: 9497468 (Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article)

Chemical References

• Gases
• Transforming Growth Factor beta

Topics

• Adult
• Aged
• Aged, 80 and over
• Blood Transfusion, Autologous
• Combined Modality Therapy
• Female
• Gases (therapeutic use)
• Humans
• Male
• Middle Aged
• Platelet Transfusion
• Postoperative Period
• Prospective Studies
• Retinal Perforations (surgery, therapy)
• Transforming Growth Factor beta (therapeutic use)
• Visual Acuity
• Vitrectomy