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Stephen Myles Potter, Omar Iqbal, Sarina Mahesh Amin, Gibran S Khurshid; A novel approach to surgical repair of visually significant lamellar macular holes. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5008.
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© ARVO (1962-2015); The Authors (2016-present)
There is no general consensus on the optimal timing and benefit of lamellar macular hole (LMH) repair. For the repair of visually-significant LMHs, vitrectomy with internal limiting membrane (ILM) peeling has been advocated in literature. We discuss an innovative surgical treatment for repairing visually significant LMHs using autologous platelets. We investigated the anatomic and functional visual outcomes of patients that underwent visually-significant LMH repair with autologous platelets.
In this retrospective case-series, preoperative and postoperative data was collected on six consecutive patients with visually significant LMHs who underwent surgical intervention using autologous platelets at the University of Florida-Gainesville between January 2015 and August 2016. Patients underwent 23G pars plana vitrectomy with removal of posterior hyaloid, air-fluid exchange, intravitreal injection of autologous platelets, and 12% C3F8 tamponade with postoperative supine positioning for four hours only. Data was collected on subjective visual complaints prior to surgical intervention, as well as postoperative subjective visual function. Anatomic LMH closure was determined based on comparison of preoperative and postoperative Heidelberg SD-OCT imaging of the macula. Preoperative and postoperative corrected distance visual acuity (CDVA) was recorded in logMAR. Charts were also reviewed for postoperative complications in the follow-up period. One-way ANOVA was used to compare mean CVDAs.
Postoperative OCT analysis revealed that all patients achieved complete anatomic LMH closure with reformation and repopulation of foveal contour. All patients also noted subjective visual improvement postoperatively. The mean preoperative CDVA was 0.86 logMAR with a standard deviation of 0.41 logMAR. The mean postoperative CDVA at 4-6 months was 0.39 logMAR with a standard deviation of 0.18. An average improvement in CDVA of 0.47 logMAR was noted postoperatively (p=0.03). Additionally, 67% of patients achieved CDVA of 0.40 logMAR or better.
Visually significant LMH repair with autologous platelets results in functional visual improvement along with anatomic resolution of LMHs. Peculiar findings included repopulation of internal retinal layers with reformation of foveal contour. This novel technique also eliminates the daunting postoperative course of prone posturing.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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