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Highly myopic macular holes

High closure rates achieved using autologous platelet-rich plasma

Cheryl Guttman Krader

Posted: Friday, February 1, 2019

Autologous platelet-rich plasma (aPRP) appears to be a valuable aid in the management of macular holes in highly myopic eyes, said Marta S Figueroa MD, at the 18th EURETINA Congress in Vienna, Austria.

“Two surgical approaches – the inverted internal limiting membrane (ILM) flap technique and autologous ILM transplantation – have been described as methods for improving results when treating highly myopic macular holes,” said Dr Figueroa, Medical Director, Vissum Madrid, Madrid, Spain.

“The use of aPRP as an adjunct to vitrectomy with ILM peeling is an easier approach that in our experience is associated with excellent surgical outcomes,” she reported.

Dr Figueroa and colleagues demonstrated the efficacy of aPRP as an adjuvant in surgery for high myopic macular holes in a prospective interventional case series that included 20 treatment-naïve eyes and eight eyes with a persistent macular hole after vitrectomy with ILM peeling. The treatment-naïve eyes underwent ILM peeling and fluid-air exchange, and received injection of three drops of aPRP over the macular hole followed by gas tamponade with 12% C3F8. Eyes with persistent macular holes were treated with aPRP and received silicone oil tamponade.

Closure after the single procedure was achieved in 19 (95%) of the naïve cases and in seven (87.5%) of the eight eyes with a persistent macular hole. Discussing the single eye with the persistent hole that failed to close, Dr Figueroa presented images showing a large dome-shaped macula that she suggested might have limited the amount of PRP reaching the macular hole.

After a mean follow-up of 21 months, visual acuity was significantly improved from 0.75 logMAR before the procedure to 0.51 logMAR. Subfoveal external limiting membrane was visible after the surgery in 19 (68%) eyes, the ellipsoid zone was visible in 15 (53%) eyes; these structures were more often seen in naïve eyes than in the group with a persistent macular hole.

MECHANISM OF ACTION
APRP becomes activated on interaction with tissues, forming a fibrin clot that releases trophic factors. It has shown to stimulate retinal wound healing and retinal regeneration.

“We believe that the healing capabilities of aPRP are especially useful for macular holes in highly myopic eyes,” said Dr Figueroa.

Dr Figueroa proposed that there are two mechanisms involved in macular hole closure with aPRP. One is the mechanical effect when activated aPRP forms a fibrin clot that covers the macular hole acting as a barrier. The second is the biological effect when aPRP releases trophic factors that may enhance Müller cells activation.

Marta S Figueroa: figueroa@servicom2000.com


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