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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.

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.

  • macular hole
  • octafluorocarbon gas
  • sulphur hexafluoride gas
  • autologous platelet concentrate
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