Surgical management of macular holes: results using gas tamponade alone, or in combination with autologous platelet concentrate, or transforming growth factor beta 2.
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 beta 2 (TGF-beta 2) or autologous platelet concentrate is reported.


METHODS
Twenty eyes had vitrectomy and 20% SF6 gas tamponade; 15 had vitrectomy, 20% SF6 gas, and TGF-beta 2; 50 had vitrectomy, 16% C3F8 gas 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-beta 2 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.


CONCLUSIONS
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.
Minihan
M
M
Department of Ophthalmology, Cork University Hospital, Wilton, Ireland.
Goggin
M
M
Cleary
P E
PE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001804:Blood Transfusion, Autologous; D003131:Combined Modality Therapy; D005260:Female; D005740:Gases / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion; D011184:Postoperative Period; D011446:Prospective Studies; D012167:Retinal Perforations / Q000601:surgery / Q000628:therapy*; D016212:Transforming Growth Factor beta / Q000627:therapeutic use*; D014792:Visual Acuity; D014821:Vitrectomy
D005740:Gases; D016212:Transforming Growth Factor beta