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Gelormini F, D'antico S, Ricardi F, Parisi G, Borrelli E, Marolo P, Conte F, Salafia M, Reibaldi M. Platelet concentrates in macular hole surgery. A journey through the labyrinth of terminology, preparation, and application: a comprehensive review. Graefes Arch Clin Exp Ophthalmol 2024; 262:2365-2388. [PMID: 38270630 PMCID: PMC11271331 DOI: 10.1007/s00417-023-06365-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/16/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024] Open
Abstract
The surgical management of macular holes is undergoing continuous evolution, with recent focus on the utilization of platelet concentrates as a promising adjunctive intervention. Currently, they present a valid surgical approach for achieving anatomical and functional success with a non-inferiority comparably to the alternative surgical techniques. Nonetheless, the utilization of varied platelet concentrates terminologies, coupled with the lack of standardization in their preparation methodologies, engenders both lexical confusion and challenges in comparing scientific studies published up until now. In this review, we summarized the published evidence concerning the application of platelet concentrates in macular holes surgery, aiming to clarify the terminology and methodologies employed and to establish a common consensus facilitating further development and diffusion of this promising technique.
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Affiliation(s)
- Francesco Gelormini
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
| | - Sergio D'antico
- Blood Bank, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Federico Ricardi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy.
| | - Guglielmo Parisi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
| | - Enrico Borrelli
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
| | - Paola Marolo
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
| | - Fabio Conte
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
| | - Marika Salafia
- Blood Bank, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
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Wang Y, Xu Z, Zhao X, Meng L, Yang J, Chen Y. THERAPEUTIC EFFECT OF USING AUTOLOGOUS PLATELET CONCENTRATE IN VITRECTOMY FOR MACULAR HOLE: A Systematic Review and Meta-Analysis. Retina 2023; 43:1833-1841. [PMID: 37607135 DOI: 10.1097/iae.0000000000003888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
PURPOSE To summarize the current evidence regarding the therapeutic effect of using autologous platelet concentrate (APC) in vitrectomy for macular hole (MH). METHODS The PubMed, Web of Science, and Embase databases were searched according to the PROSPERO protocol (CRD42022366202). Controlled trials comparing whether APC was used in the vitrectomy of MH were included. The primary outcome was the closure rate of MH and postoperative best-corrected visual acuity, and the secondary outcome was the incidence of different types of complications. RESULTS Seven studies that included 634 eyes were eligible. For the primary outcome, the usage of APC significantly improved the closure rate of MH in vitrectomy (odds ratio [OR] = 5.34, 95% confidence interval, 2.83-10.07, P < 0.001). Postoperative visual acuity did not significantly differ between the APC group and similar baseline controls (SMD = -0.07, 95% confidence interval, -0.35 to 0.22, P = 0.644). For the secondary outcome, using APC did not result in additional complications regarding postoperative retinal detachment or the recurrence of MH. CONCLUSION The use of APC in vitrectomy was associated with a superior closure rate of the hole and no additional complications; therefore, it is effective and safe in MH surgery.
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Affiliation(s)
- Yuelin Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; and
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhengbo Xu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; and
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xinyu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; and
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lihui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; and
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingyuan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; and
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; and
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Buzzi M, Parisi G, Marolo P, Gelormini F, Ferrara M, Raimondi R, Allegrini D, Rossi T, Reibaldi M, Romano MR. The Short-Term Results of Autologous Platelet-Rich Plasma as an Adjuvant to Re-Intervention in the Treatment of Refractory Full-Thickness Macular Holes. J Clin Med 2023; 12:jcm12052050. [PMID: 36902837 PMCID: PMC10004127 DOI: 10.3390/jcm12052050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
The purpose of this study was to investigate the short-term efficacy and safety of autologous platelet-rich plasma (a-PRP) as an adjuvant to revisional vitrectomy for refractory full-thickness macular holes (rFTMHs). We conducted a prospective, non-randomized interventional study including patients with rFTMH after a pars plana vitrectomy (PPV) with internal limiting membrane peeling and gas tamponade. We included 28 eyes from 27 patients with rFTMHs: 12 rFTMHs in highly myopic eyes (axial length greater than 26.5 mm or a refractive error greater than -6D or both); 12 large rFTMHs (minimum hole width > 400 μm); and 4 rFTMHs secondary to the optic disc pit. All patients underwent 25-G PPV with a-PRP, a median time of 3.5 ± 1.8 months after the primary repair. At the six-month follow-up, the overall rFTMH closure rate was 92.9%, distributed as follows: 11 out of 12 eyes (91.7%) in the highly myopic group, 11 out of 12 eyes (91.7%) in the large rFTMH group, and 4 out of 4 eyes (100%) in the optic disc pit group. Median best-corrected visual acuity significantly improved in all groups, in particular from 1.00 (interquartile range: 0.85 to 1.30) to 0.70 (0.40 to 0.85) LogMAR in the highly myopic group (p = 0.016), from 0.90 (0.70 to 1.49) to 0.40 (0.35 to 0.70) LogMAR in the large rFTMH group (p = 0.005), and from 0.90 (0.75 to 1.00) to 0.50 (0.28 to 0.65) LogMAR in the optic disc pit group. No intraoperative or postoperative complications were reported. In conclusion, a-PRP can be an effective adjuvant to PPV in the management of rFTMHs.
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Affiliation(s)
- Matilde Buzzi
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
- Correspondence: (M.B.); (M.R.R.)
| | - Guglielmo Parisi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10124 Turin, Italy
| | - Paola Marolo
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10124 Turin, Italy
| | - Francesco Gelormini
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10124 Turin, Italy
| | - Mariantonia Ferrara
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Raffaele Raimondi
- Eye Unit, Department of Ophthalmology, Humanitas Gavazzeni-Castelli, 24125 Bergamo, Italy
| | - Davide Allegrini
- Eye Unit, Department of Ophthalmology, Humanitas Gavazzeni-Castelli, 24125 Bergamo, Italy
| | | | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10124 Turin, Italy
| | - Mario R. Romano
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
- Eye Unit, Department of Ophthalmology, Humanitas Gavazzeni-Castelli, 24125 Bergamo, Italy
- Correspondence: (M.B.); (M.R.R.)
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Surgical Management of Recurrent and Persistent Macular Holes: A Practical Approach. Ophthalmol Ther 2021; 10:1137-1153. [PMID: 34494236 PMCID: PMC8589910 DOI: 10.1007/s40123-021-00388-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/09/2021] [Indexed: 12/28/2022] Open
Abstract
Primary surgery for macular hole (MH) closure has a high success rate with current methods of pars plana vitrectomy and internal limiting membrane (ILM) peeling. When primary surgery fails, there are several options available for secondary repair, including extension of the ILM peel, creation of an ILM flap, pedunculated ILM flap, lens capsule flap transplantation, autologous retinal transplantation, use of a human amniotic membrane plug, adjuvant autologous platelet concentrate, induction of macular detachments with subretinal blebs, and creation of retinal incisions. In this review, we discuss the practical approach to each of these surgical techniques for the management of recurrent or persistent MHs.
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Ruzafa N, Pereiro X, Fonollosa A, Araiz J, Acera A, Vecino E. Plasma Rich in Growth Factors (PRGF) Increases the Number of Retinal Müller Glia in Culture but Not the Survival of Retinal Neurons. Front Pharmacol 2021; 12:606275. [PMID: 33767620 PMCID: PMC7985077 DOI: 10.3389/fphar.2021.606275] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/02/2021] [Indexed: 01/19/2023] Open
Abstract
Plasma rich in growth factors (PRGF) is a subtype of platelet-rich plasma (PRP) that stimulates tissue regeneration and may promote neuronal survival. It has been employed in ophthalmology to achieve tissue repair in some retinal pathologies, although how PRGF acts in the retina is still poorly understood. As a part of the central nervous system, the retina has limited capacity for repair capacity following damage, and retinal insult can provoke the death of retinal ganglion cells (RGCs), potentially producing irreversible blindness. RGCs are in close contact with glial cells, such as Müller cells, that help maintain homeostasis in the retina. In this study, the aim was to determine whether PRGF can protect RGCs and whether it increases the number of Müller cells. Therefore, PRGF were tested on primary cell cultures of porcine RGCs and Müller cells, as well as on co-cultures of these two cell types. Moreover, the inflammatory component of PRGF was analyzed and the cytokines in the different PRGFs were quantified. In addition, we set out to determine if blocking the inflammatory components of PRGF alters its effect on the cells in culture. The presence of PRGF compromises RGC survival in pure cultures and in co-culture with Müller cells, but this effect was reversed by heat-inactivation of the PRGF. The detrimental effect of PRGF on RGCs could be in part due to the presence of cytokines and specifically, to the presence of pro-inflammatory cytokines that compromise their survival. However, other factors are likely to be present in the PRGF that have a deleterious effect on the RGCs since the exposure to antibodies against these cytokines were insufficient to protect RGCs. Moreover, PRGF promotes Müller cell survival. In conclusion, PRGF hinders the survival of RGCs in the presence or absence of Müller cells, yet it promotes Müller cell survival that could be the reason of retina healing observed in the in vivo treatments, with some cytokines possibly implicated. Although PRGF could stimulate tissue regeneration, further studies should be performed to evaluate the effect of PRGF on neurons and the implication of its potential inflammatory role in such processes.
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Affiliation(s)
- Noelia Ruzafa
- Experimental Ophthalmo-Biology Group, Department of Cell Biology and Histology, University of Basque Country UPV/EHU, Leioa, Spain.,Begiker-Ophthalmology Research Group, Cruces Hospital, BioCruces Health Research Institute, Bilbao, Spain
| | - Xandra Pereiro
- Experimental Ophthalmo-Biology Group, Department of Cell Biology and Histology, University of Basque Country UPV/EHU, Leioa, Spain.,Begiker-Ophthalmology Research Group, Cruces Hospital, BioCruces Health Research Institute, Bilbao, Spain
| | - Alex Fonollosa
- Experimental Ophthalmo-Biology Group, Department of Cell Biology and Histology, University of Basque Country UPV/EHU, Leioa, Spain.,Begiker-Ophthalmology Research Group, Cruces Hospital, BioCruces Health Research Institute, Bilbao, Spain.,Department of Ophthalmology, University of Basque Country UPV/EHU, Leioa, Spain
| | - Javier Araiz
- Experimental Ophthalmo-Biology Group, Department of Cell Biology and Histology, University of Basque Country UPV/EHU, Leioa, Spain.,Department of Ophthalmology, University of Basque Country UPV/EHU, Leioa, Spain
| | - Arantxa Acera
- Experimental Ophthalmo-Biology Group, Department of Cell Biology and Histology, University of Basque Country UPV/EHU, Leioa, Spain.,Biodonostia Health Research Institute, Donostia Hospital, San Sebastian, Spain
| | - Elena Vecino
- Experimental Ophthalmo-Biology Group, Department of Cell Biology and Histology, University of Basque Country UPV/EHU, Leioa, Spain.,Begiker-Ophthalmology Research Group, Cruces Hospital, BioCruces Health Research Institute, Bilbao, Spain
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Ruzafa N, Pereiro X, Fonollosa A, Araiz J, Acera A, Vecino E. The Effect of Plasma Rich in Growth Factors on Microglial Migration, Macroglial Gliosis and Proliferation, and Neuronal Survival. Front Pharmacol 2021; 12:606232. [PMID: 33716738 PMCID: PMC7953148 DOI: 10.3389/fphar.2021.606232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/25/2021] [Indexed: 12/21/2022] Open
Abstract
Plasma rich in growth factors (PRGF) is a subtype of platelet-rich plasma that has being employed in the clinic due to its capacity to accelerate tissue regeneration. Autologous PRGF has been used in ophthalmology to repair a range of retinal pathologies with some efficiency. In the present study, we have explored the role of PRGF and its effect on microglial motility, as well as its possible pro-inflammatory effects. Organotypic cultures from adult pig retinas were used to test the effect of the PRGF obtained from human as well as pig blood. Microglial migration, as well as gliosis, proliferation and the survival of retinal ganglion cells (RGCs) were analyzed by immunohistochemistry. The cytokines present in these PRGFs were analyzed by multiplex ELISA. In addition, we set out to determine if blocking some of the inflammatory components of PRGF alter its effect on microglial migration. In organotypic cultures, PRGF induces microglial migration to the outer nuclear layers as a sign of inflammation. This phenomenon could be due to the presence of several cytokines in PRGF that were quantified here, such as the major pro-inflammatory cytokines IL-1β, IL-6 and TNFα. Heterologous PRGF (human) and longer periods of cultured (3 days) induced more microglia migration than autologous porcine PRGF. Moreover, the migratory effect of microglia was partially mitigated by: 1) heat inactivation of the PRGF; 2) the presence of dexamethasone; or 3) anti-cytokine factors. Furthermore, PRGF seems not to affect gliosis, proliferation or RGC survival in organotypic cultures of adult porcine retinas. PRGF can trigger an inflammatory response as witnessed by the activation of microglial migration in the retina. This can be prevented by using autologous PRGF or if this is not possible due to autoimmune diseases, by mitigating its inflammatory effect. In addition, PRGF does not increase either the proliferation rate of microglial cells or the survival of neurons. We cannot discard the possible positive effect of microglial cells on retinal function. Further studies should be performed to warrant the use of PRGF on the nervous system.
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Affiliation(s)
- Noelia Ruzafa
- Experimental Ophthalmo-Biology Group (GOBE, www-ehu.eus/GOBE), Department of Cell Biology and Histology, University of Basque Country UPV/EHU, Leioa, Spain
- Begiker-Ophthalmology Research Group, BioCruces Health Research Institute, Cruces Hospital, Bilbao, Spain
| | - Xandra Pereiro
- Experimental Ophthalmo-Biology Group (GOBE, www-ehu.eus/GOBE), Department of Cell Biology and Histology, University of Basque Country UPV/EHU, Leioa, Spain
- Begiker-Ophthalmology Research Group, BioCruces Health Research Institute, Cruces Hospital, Bilbao, Spain
| | - Alex Fonollosa
- Experimental Ophthalmo-Biology Group (GOBE, www-ehu.eus/GOBE), Department of Cell Biology and Histology, University of Basque Country UPV/EHU, Leioa, Spain
- Begiker-Ophthalmology Research Group, BioCruces Health Research Institute, Cruces Hospital, Bilbao, Spain
- Department of Ophthalmology, University of Basque Country UPV/EHU, Leioa, Spain
| | - Javier Araiz
- Experimental Ophthalmo-Biology Group (GOBE, www-ehu.eus/GOBE), Department of Cell Biology and Histology, University of Basque Country UPV/EHU, Leioa, Spain
- Begiker-Ophthalmology Research Group, BioCruces Health Research Institute, Cruces Hospital, Bilbao, Spain
| | - Arantxa Acera
- Experimental Ophthalmo-Biology Group (GOBE, www-ehu.eus/GOBE), Department of Cell Biology and Histology, University of Basque Country UPV/EHU, Leioa, Spain
- Biodonostia Health Research Institute, Donostia Hospital, San Sebastian, Spain
| | - Elena Vecino
- Experimental Ophthalmo-Biology Group (GOBE, www-ehu.eus/GOBE), Department of Cell Biology and Histology, University of Basque Country UPV/EHU, Leioa, Spain
- Begiker-Ophthalmology Research Group, BioCruces Health Research Institute, Cruces Hospital, Bilbao, Spain
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Surgical treatment of macular holes with and without the use of autologous platelet-rich plasma. Int Ophthalmol 2021; 41:1043-1052. [PMID: 33392943 DOI: 10.1007/s10792-020-01662-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the results of treatment of idiopathic full-thickness macular holes (MHs) with and without the use of autologous platelet-rich plasma (APRP). METHODS This partially retrospective study included 152 patients (152 eyes) with MHs operated in the years 2010-2014 using conventional technology with internal limiting membrane peeling (control group) and 62 patients (62 eyes), operated by the same surgeons in 2015-2017 with additional application of APRP on MH (platelet group). Pre and postoperative best-corrected visual acuities (BCVA) were recorded, and retinal microstructure was studied using optical coherence tomography. Thirty-seven patients in the platelet group and 80 controls were followed for at least 12 months (for visual outcomes 15 controls were followed for 15-24 months). The data of 72 controls (72 eyes) were analyzed retrospectively. RESULTS The minimum diameter of the MH in the platelet group was larger than in controls: 454 ± 186 vsersus 381 ± 148 μm (P = 0.003). Despite this, all MHs in the platelet group were closed, while in the control group 11 holes (7.2%) remained open (P = 0.036). The final mean BCVA, standardized by the minimum diameter of the macular hole, was higher in the platelet group by 3.9 ETDRS letters (P = 0.012). After surgery with APRP, foveal hyperreflective lesion (presumably glial proliferation) was found, which persisted in most large MHs, but gradually disappeared in small and most medium MHs. CONCLUSION The use of APRP significantly improves the anatomical and functional results of treatment of idiopathic MHs. In very large MHs, APRP presumably enhances glial proliferation, which ensures their closure.
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Use of Autologous Platelets for Lamellar Macular Hole Repair. Case Rep Ophthalmol Med 2019; 2019:1471754. [PMID: 31236297 PMCID: PMC6545778 DOI: 10.1155/2019/1471754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 05/08/2019] [Indexed: 11/29/2022] Open
Abstract
The consensus of lamellar macular hole repair generally entails vitrectomy with internal limiting membrane with/without epiretinal membrane peeling with gas tamponade, although the risk of a full thickness macular hole remains. In this case report, we investigate the role of the regenerative properties of autologous platelets in the repair of a lamellar macular hole with pars plana vitrectomy, an autologous platelet plug, and 12% C3F8 without prone posturing. All three patients in this case report experienced visual improvement along with anatomic closure of the lamellar macular hole. Further randomized studies with larger sample sizes will contribute to the existing data regarding this procedure and its outcomes.
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Grewal DS, Charles S, Parolini B, Kadonosono K, Mahmoud TH. Autologous Retinal Transplant for Refractory Macular Holes: Multicenter International Collaborative Study Group. Ophthalmology 2019; 126:1399-1408. [PMID: 30711606 DOI: 10.1016/j.ophtha.2019.01.027] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/16/2019] [Accepted: 01/26/2019] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To report the structural and functional outcomes of autologous neurosensory retinal transplant for closure of refractory large macular holes (MHs). DESIGN Multicenter, retrospective, consecutive case series. PARTICIPANTS A total of 41 eyes of 41 patients with a full-thickness MH refractory to prior vitrectomy with internal limiting membrane (ILM) peel and tamponade. METHODS All patients underwent pars plana vitrectomy, autologous neurosensory retinal transplant with gas, silicone oil tamponade, or short-term perfluoro-n-octane heavy-liquid tamponade. All patients had at least 6 months' follow-up. MAIN OUTCOME MEASURES Anatomic closure of MH, change in ellipsoid zone (EZ) and external limiting membrane (ELM) defect on OCT, visual acuity (VA) recovery, and surgical complications were analyzed. RESULTS Mean number of prior surgeries was 1.5±0.94 (range, 1-3), and patients were followed for a mean of 11.1±7.7 months (range, 6-36 months). Complete anatomic closure of MH by OCT was achieved in 36 of 41 eyes (87.8%). Mean corrected VA (logarithm of the minimum angle of resolution [logMAR]) improved (P = 0.03) from 1.11±0.66 (range, 0.48-3) to 1.03±0.51 (range, 0.1-2) at the last postoperative visit. The VA improved (≥0.3 logMAR units) in 15 eyes (36.6%), was stable in 17 eyes (41.5%), and worsened in 9 eyes (21.9%). Among eyes with anatomic closure, VA improved in 52.3% and worsened in 13.8%, whereas in those without closure, VA worsened in 40% and improved in none. Mean preoperative largest basal diameter was 1468.1±656.4 μm (range, 621-2600 μm), and mean inner-opening diameter was 825±422.5 μm (range, 336-1649 μm). Mean preoperative EZ defect was 1777.3±513.8 μm (range, 963-2808 μm), which decreased to 1370±556.9 μm (range, 288-2000 μm) at final follow-up (P = 0.007). Mean preoperative ELM was 1681.5±429 μm (range, 1172-2606 μm), which decreased to 1408.5±571.2 μm (range, 200-2000 μm) at final follow-up (P = 0.017). Major postoperative complications were retinal detachment (n = 1) and vitreous hemorrhage (n = 1). There were no cases of proliferative vitreoretinopathy, endophthalmitis, suprachoroidal hemorrhage, or choroidal neovascularization. CONCLUSIONS The autologous retinal transplant technique offers a high degree of anatomic success and proved safe in this initial experience for closure of refractory MHs.
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Affiliation(s)
- Dilraj S Grewal
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | | | - Barbara Parolini
- Department of Ophthalmology, Sant'Anna Institute, Brescia, Italy
| | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Tamer H Mahmoud
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Associated Retinal Consultants, Royal Oak, Michigan.
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Nadal J, Figueroa MS, Carreras E, Pujol P, Canut MI, Barraquer RI. Autologous platelet concentrate in surgery for macular detachment associated with congenital optic disc pit. Clin Ophthalmol 2015; 9:1965-71. [PMID: 26543348 PMCID: PMC4622553 DOI: 10.2147/opth.s81976] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the anatomical and functional results obtained with pars plana vitrectomy (PPV) plus autologous platelet concentrate (APC) as a treatment for macular detachment associated with optic disc pit (ODP). Methods We performed a prospective interventional study of 19 eyes of 19 consecutive patients with posterior macular detachment due to ODP. All patients underwent PPV, posterior hyaloid peeling, fluid–air exchange, injection of 0.05 mL of APC over the ODP and 15% perfluoropropane (C3F8) endotamponade. Postoperative measures included face-up positioning for 2 hours and then avoidance of the face-up position during the ensuing 10 days. All patients underwent complete ophthalmologic examination and optical coherence tomography preoperatively at 1 month, 3 months, 6 months, 9 months, and 12 months postoperatively and then annually. Outcome measures were best corrected visual acuity (BCVA) by logMAR, improvement of quality of vision, macular attachment, and resolution of intraretinal schisis-like separation. Results Preoperatively, the median BCVA was 0.70 (range: 0.30–1.70) and all patients showed improved visual acuity after surgery; BCVA was 0.22 (range: 0.07–0.52) at 12 months follow-up. All patients showed complete reabsorption of intraretinal fluid (median time: 3.5 months [range: 2–8 months]) and macular attachment at the end of follow-up (median: 60 months [range: 12–144 months]), with stable or improved visual acuity. No reoperations were needed and no major adverse events were recorded. Conclusion For macular detachment associated with ODP, the combination of PPV, posterior hyaloid peeling, APC, and C3F8 tamponade is a highly effective alternative technique with stable anatomical and functional results.
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Affiliation(s)
- Jeroni Nadal
- Vitreoretinal Surgery Department at Centro de Oftalmología Barraquer, Barcelona, Spain ; Universitat autónoma de Barcelona, Barcelona, Spain
| | | | - Elisa Carreras
- Universitat autónoma de Barcelona, Barcelona, Spain ; Instituto Barraquer, Barcelona, Spain
| | - Patricia Pujol
- Universitat autónoma de Barcelona, Barcelona, Spain ; Instituto Barraquer, Barcelona, Spain
| | - Maria Isabel Canut
- Universitat autónoma de Barcelona, Barcelona, Spain ; Instituto Barraquer, Barcelona, Spain ; Glaucoma Department at Centro de Oftalmología Barraquer, Barcelona, Spain
| | - Rafael Ignacio Barraquer
- Universitat autónoma de Barcelona, Barcelona, Spain ; Cornea and Cataract Surgery Department at Centro de Oftalmología Barraquer, Barcelona, Spain
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Nugent RB, Lee GA. Ophthalmic use of blood-derived products. Surv Ophthalmol 2015; 60:406-34. [PMID: 26077627 DOI: 10.1016/j.survophthal.2015.03.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/23/2015] [Accepted: 03/25/2015] [Indexed: 12/23/2022]
Abstract
There is a wide spectrum of blood-derived products that have been used in many different medical and surgical specialties with success. Blood-derived products for clinical use can be extracted from autologous or allogeneic specimens of blood, but recombinant products are also commonly used. A number of blood derivatives have been used for a wide range of ocular conditions, from the ocular surface to the retina. With stringent preparation guidelines, the potential risk of transmission of blood-borne diseases is minimized. We review blood-derived products and how they are improving the management of ocular disease.
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Affiliation(s)
| | - Graham A Lee
- City Eye Centre, Brisbane, Queensland, Australia; Department of Ophthalmology, University of Queensland, Brisbane, Queensland, Australia.
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Kapoor KG, Khan AN, Tieu BC, Khurshid GS. Revisiting Autologous Platelets as an Adjuvant in Macular Hole Repair: Chronic Macular Holes Without Prone Positioning. Ophthalmic Surg Lasers Imaging Retina 2012; 43:291-5. [DOI: 10.3928/15428877-20120426-03] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 02/21/2012] [Indexed: 11/20/2022]
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BLOOD CLUMP–ASSISTED VITRECTOMY AND INTERNAL LIMITING MEMBRANE PEELING FOR MACULAR HOLE REPAIR. Retina 2011; 31:2014-20. [DOI: 10.1097/iae.0b013e31821504a5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ghazi NG, Daccache A, Knape R, Tiedeman JS. Combined pars plana lensectomy/vitrectomy for idiopathic macular hole repair without postoperative prone positioning. Digit J Ophthalmol 2008; 14:56-63. [PMID: 29440983 DOI: 10.5693/djo.01.2008.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose The aim of this study is to determine the anatomic and visual outcomes following combined pars plana lensectomy/vitrectomy (CPPLV) as a primary procedure for idiopathic macular hole (MH) without post-operative prone positioning (PPP). Materials and Methods A retrospective chart review of 42 patients (47 eyes) with MH who underwent CPPLV was performed. No PPP was performed; however, patients were instructed to avoid the supine position during the first postoperative week. The main outcome measures included MH closure rate, best corrected post-operative Snellen visual acuity (BCVA), and procedure complications. Results Anatomical closure was achieved in 44 eyes (93.6%). The average BCVA in these eyes improved from 20/203 at baseline to 20/91 post-operatively, with 28 (63.6%) having 20/40 or better. Twenty-eight (59.6%) of the 47 eyes had a BCVA of 20/40 or better post-operatively and 35 (74.5%) eyes improved by at least 2 Snellen lines. Post-operative retinal detachment (RD) was observed in 4 eyes (8.5%) and late reopening of the hole in 4 (9.1%). Discussion The anatomical and visual outcomes and the RD rate of CPPLV with sulcus intraocular lens implantation without PPP are comparable to those of traditional MH surgery techniques. The main advantages include sparing the patient the inconvenience of PPP and eliminating the need for additional post-vitrectomy cataract extraction procedure.
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Valldeperas X, Wong D. Is It Worth Reoperating on Macular Holes? Ophthalmology 2008; 115:158-63. [PMID: 17512597 DOI: 10.1016/j.ophtha.2007.01.039] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 01/31/2007] [Accepted: 01/31/2007] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To evaluate the visual outcome after a second surgical attempt to close idiopathic full-thickness macular holes (FTMH) in patients who underwent unsuccessful primary surgery and in patients with reopened FTMHs. DESIGN Retrospective single-center case series. PARTICIPANTS Five hundred thirty-two patients underwent surgery for FTMH in St. Paul's Eye Unit, Liverpool, United Kingdom, between March, 1995, and March, 2005. Fifty-one patients had unclosed FTMHs (unclosed group) and 21 patients had reopened FTMHs after initially successful surgery (reopened group). METHODS All patients underwent a second pars plana vitrectomy. Autologous platelet concentrate and perfluoropropane endotamponade were used. Internal limiting membrane peeling was carried out in selected cases. Patients were instructed to maintain a face-down position for 2 weeks after the surgery. MAIN OUTCOME MEASURES Anatomic and visual results. RESULTS All patients in the reopened group and 76% of patients in the unclosed group achieved successfully closure of the FTMH after the second surgery. Mean decimal Snellen visual acuity (VA; +/-standard deviation [SD]) before the second surgery was 0.14+/-0.10 (range, 0.01-0.33) in the reopened group and 0.10+/-0.07 (range, hand movements [HM]-0.33) in the unclosed group. The best VA was achieved after cataract surgery; the mean best VA (+/-SD) in the reopened group was 0.42+/-0.31 (range, 0.05-1) and in the unclosed group was 0.19+/-0.14 (range, HM-0.66). CONCLUSIONS Reoperating on reopened FTMH resulted in 100% anatomic closure and significant improvement in vision. In contrast, reoperating on patients with initially unsuccessful surgery resulted a lower anatomic closure rate and relatively poor final vision even if their macular holes were closed successfully. This information may help surgeons and patients decide whether to undertake a second operation.
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