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Surgical treatment of macular holes with and without the use of autologous platelet-rich plasma

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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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Availability of data and materials

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors are grateful to Ilias Kh. Sharafetdinov, MD, Ph.D for performing part of the surgeries and to Olga A. Yukhanova for performing optical coherence tomography in the control group.

Funding

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Authors and Affiliations

  1. The S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation

    Alexander A. Shpak, Dmitry O. Shkvorchenko & Eugenia A. Krupina

Authors
  1. Alexander A. Shpak
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  2. Dmitry O. Shkvorchenko
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  3. Eugenia A. Krupina
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Contributions

AS conceived and designed the research, drafted the manuscript. DS performed surgeries. EK performed examinations. AS, DS, and EK analyzed and interpreted the data. DS, EK made critical revision of the manuscript.

Corresponding author

Correspondence to Alexander A. Shpak.

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Conflicts of interest

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Ethical approval

This study adhered to the tenets of the HELSINKI declaration and was approved by the Local Ethics Committee of The S. Fyodorov Eye Microsurgery Federal State Institution. Informed consent was obtained from all subjects included in the study.

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Shpak, A.A., Shkvorchenko, D.O. & Krupina, E.A. Surgical treatment of macular holes with and without the use of autologous platelet-rich plasma. Int Ophthalmol 41, 1043–1052 (2021). https://doi.org/10.1007/s10792-020-01662-4

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