title: Blood-assisted internal limiting membrane peeling for macular hole repair.
abstract: OBJECTIVE
  To evaluate the efficacy of autologous heparinized whole blood in assisting internal limiting membrane (ILM) peeling by coating the ILM for macular hole (MH) repair.
  
  
  METHODS
  Prospective, interventional case series.
  
  
  METHODS
  Twenty-nine patients (32 eyes) who underwent blood-assisted ILM peeling for MH repair.
  
  
  METHODS
  Patients in whom stage 2-4 idiopathic MHs had developed and who desired surgery were enrolled in this study. After core vitrectomy, autologous heparinized whole blood was applied to cover the macula and to coat the surface of the macular area in the fluid-filled vitreous cavity. The redundant blood was removed and only a very thin film of blood was left on the macular area. The blood-coated ILM was removed by forceps in a circular fashion. To confirm the removed membrane was the ILM, the first 10 specimens were examined by electron microscopy (EM).
  
  
  METHODS
  The MH closure rate, the interval mean visual acuity (before and after surgery), retinal changes, and the EM results of the ILM specimens.
  
  
  RESULTS
  All 32 eyes in 29 patients completed 12 months of follow-up. The ILM were coated by autologous heparinized whole blood, removed without difficulty, and confirmed by EM. The whole blood highlighted the contrast of the coated and noncoated areas during the ILM peeling procedure. The MHs were closed in all surgical eyes with a single surgery (100%). Compared with study entry, the mean logMAR best-corrected visual acuity 12 months after surgery improved significantly (1.02 and 0.53, respectively; P<0.001). At 12 months of follow-up, 31 eyes (96.9%) had stable or improved vision. No toxic fundus changes were observed during follow-up.
  
  
  CONCLUSIONS
  Autologous heparinized whole blood coated the ILM and facilitated visibility during ILM peeling. Autologous heparinized whole blood is a cost-effective and useful tool for assisting MH surgery.
authors.affiliation: Department of Ophthalmology, Chang-Gung Memorial Hospital, Taoyuan, Taiwan. CCL404@cgmh.org.tw
authors.forename: Chi-Chun
authors.initials: CC
authors.lastname: Lai
authors.forename: Yih-Shiou
authors.initials: YS
authors.lastname: Hwang
authors.forename: Laura
authors.initials: L
authors.lastname: Liu
authors.forename: Kuan-Jen
authors.initials: KJ
authors.lastname: Chen
authors.forename: Wei-Chi
authors.initials: WC
authors.lastname: Wu
authors.forename: Lan-Hsin
authors.initials: LH
authors.lastname: Chuang
authors.forename: Jane Zea-Chin
authors.initials: JZ
authors.lastname: Kuo
authors.forename: Tun-Lu
authors.initials: TL
authors.lastname: Chen
mesh_terms: D001485:Basement Membrane / Q000601:surgery* / Q000648:ultrastructure; D001769:Blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011446:Prospective Studies; D012167:Retinal Perforations / Q000601:surgery*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy