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Br J Ophthalmol 1997;81:1073-1079 doi:10.1136/bjo.81.12.1073
  • Original Article
    • Clinical science

Surgical management of macular holes: results using gas tamponade alone, or in combination with autologous platelet concentrate, or transforming growth factor β2

  1. M Minihan,
  2. M Goggin,
  3. P E Cleary
  1. Department of Ophthalmology, Cork University Hospital and University College Cork, Wilton, Cork, Ireland
  1. Ms Miriam Minihan, Department of Ophthalmology, Cork University Hospital, Wilton, Cork, Ireland.
  • Accepted 13 August 1997

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 β2 (TGF-β2) or autologous platelet concentrate is reported.

METHODS Twenty eyes had vitrectomy and 20% SF6 gas tamponade; 15 had vitrectomy, 20% SF6gas, and TGF-β2; 50 had vitrectomy, 16% C3F8gas 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-β2, 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.

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