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SA Mertens, K Engelmann; Autologous Platelet Concentrate as an Adjuvant in Vitreoretinal Surgery for Idiopathic Macular Holes . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2483.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:A prospective clinical study was designed to evaluate the anatomical and functional outcome after macular hole surgery using autologous platelet concentrate combined with peeling of the internal limiting membrane (ILM). Methods:47 eyes with idiopathic macular holes stadium II-IV (Gass) were included in this study. All eyes underwent vitrectomy, ILM peeling, incubation with autologous platelet concentrate (APC) or serum followed by gas endotamponade. All surgerys were performed by one surgeon between January 1999 and September 2001. In 11 eyes ILM peeling was performed using indocyanin green (ICG) combined with APC incubation. Anatomical outcome was evaluated by optical coherence tomography (OCT). Results:History of macular holes before surgery ranged from 4 weeks to 2 years (mean 19.9 weeks). Preoperative mean visual acuity was 20/100 (20/800 – 20/50). 36 eyes were incubated with APC compared to 11 eyes with serum. 34 of the 36 eyes of the APC group and all eyes of the serum incubated group have been followed up. Mean follow up time was 7.4 months ranging from 2 – 24. After APC incubation 31/34 (91.2 %) macular holes were anatomically closed after one surgery compared to 8/11 (72.7 %) in the serum group. Successful treatment was achieved after revision surgery in 2 of the 3 cases (APC group) of failing macular hole closure. After APC treatment 20/34 (58.8 %) eyes achieved a visual improvement of one or more lines compared to 36.3 % serum incubated eyes. An improvement of two or more lines was observed in 16/34 (47.1 %) eyes after APC assisted treatment (18.1 % in the serum group). 10/47 eyes developed a visual acuity impairing cataract during follow up. 5 eyes showed no changes of visual acuity after APC application. 9 eyes decreased in their visual acuity postoperatively (APC), whereas 2 of these eyes underwent revision surgery because of failing hole closure. Macular hole closure occurred in all eyes treated with ICG assisted ILM-peeling and APC incubation. Conclusion:Anatomical success rates in APC treated eyes are higher than in the serum group. Furthermore relevant visual improvement could be achieved in 47.1 % after APC incubation. Single cases of macular pigmentepithelial alterations have been observed in the group treated with ICG assisted ILM-peeling. Analysis of different factors (ILM-peeling, ICG, growth factors) on anatomical and visual outcome should be of interest in future studies.
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