Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 2089
  • Home
  • Print this page
  • Email this page

   Table of Contents      
ORIGINAL ARTICLE
Year : 2020  |  Volume : 68  |  Issue : 5  |  Page : 880-884

Comparison of platelet-rich plasma and inverted internal limiting membrane flap for the management of large macular holes: A pilot study


Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India

Date of Submission27-Jul-2019
Date of Acceptance01-Nov-2019
Date of Web Publication20-Apr-2020

Correspondence Address:
Dr. Naresh Babu
Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1357_19

Rights and Permissions
  Abstract 


Purpose: To compare the safety and efficacy of 25-gauge pars plana vitrectomy (PPV) with either platelet-rich plasma (PRP) or inverted internal limiting membrane (ILM) flap for the treatment of large macular hole. Methods: Pseudophakic patients with idiopathic macular holes with a minimum diameter (MD) of 600–1500 μm were randomized into two groups (30 patients each): 25-gauge PPV with either inverted ILM flap (group A) or PRP (group B). Results: Mean MD in groups A and B were 803.33 ± 120.65 μm and 784.73 ± 120.10 μm, respectively (P = 0.552). Mean base diameter in groups A and B was 1395.17 ± 240.57 μm and 1486.90 ± 281.61 μm, respectively (P = 0.180). The median presenting best-corrected visual acuity (BCVA) was logMAR 0.78 (range 0.78–1.00) and logMAR 0.78 (Range 0.60–1.00) in groups A and B, respectively (P = 0.103). Anatomical closure was achieved in 90% (n = 27/30) and 93.3% (n = 28/30) eyes in groups A and B, respectively (P = 0.158). Type 1 closure was achieved in 76.7% (n = 23/30) and 83.3% (n = 25/30) eyes in groups A and B, respectively. Median BCVA at postoperative 3-month in groups A and B was logMAR 0.60 (range 0.48–0.60) and logMAR 0.60 (range 0.48–0.78), respectively (P = 0.312). The average visual improvement was 2.0 and 2.5 early treatment diabetic retinopathy study (ETDRS) lines in groups A and B, respectively (P = 0.339). None of the patients developed postoperative exaggerated inflammatory reactions. Conclusion: Using platelets for the treatment of large macular holes is as safe and effective as an inverted ILM flap.

Keywords: Efficacy, inverted internal limiting membrane flap, large macular hole, platelet-rich plasma, safety


How to cite this article:
Babu N, Kohli P, Ramachandran N O, Adenuga OO, Ahuja A, Ramasamy K. Comparison of platelet-rich plasma and inverted internal limiting membrane flap for the management of large macular holes: A pilot study. Indian J Ophthalmol 2020;68:880-4

How to cite this URL:
Babu N, Kohli P, Ramachandran N O, Adenuga OO, Ahuja A, Ramasamy K. Comparison of platelet-rich plasma and inverted internal limiting membrane flap for the management of large macular holes: A pilot study. Indian J Ophthalmol [serial online] 2020 [cited 2020 Jun 4];68:880-4. Available from: http://www.ijo.in/text.asp?2020/68/5/880/282928



Owing to its high success rates, macular hole (MH) surgeries are one of the favorite surgeries of the vitreoretinal surgeons.[1],[2] However, a large MH still remains a surgical challenge as they are associated with the high risk of surgical failure and poor visual gain.[1],[2],[3],[4] Chhablani et al. demonstrated that the predicted probability of type 1 closure was 100% only if the minimum diameter (MD) of hole is <300 μm, around 20–80% if MD is 600–900 μm, and only <20% if MD is >1000 μm.[2]

A number of techniques such as retina expansion technique, MH hydrodissection, arcuate retinotomy, and anterior lens capsular flap transplantation have been described for the treatment of large MHs.[5],[6],[7],[8] Michalewska et al.described the inverted internal limiting membrane (ILM) flap technique, which changed the way large MHs are treated worldwide.[9]Several studies have proved that the surgical outcome of large MH is better with inverted ILM flap compared to conventional ILM peeling.[9],[10],[11],[12],[13]

Clinical practice throughout the world is now moving toward regenerative medicine.[14] One of the regenerative agents currently used is platelet-rich plasma (PRP), which releases high levels of growth factors and bioactive molecules in physiologic proportions. This hastens the natural healing process by enhancing directed cell migration, proliferation, and differentiation. It has been successfully utilized in the fields of plastic, cosmetic, reconstructive, oral, and orthopedic surgery.[15],[16],[17] Although the use of platelets for the treatment of MH has previously been reported, literature lacks studies comparing its efficiency with inverted ILM flap in large MH.[5],[18],[19],[20],[21],[22]

We compared the safety and efficacy of 25-gauge pars plana vitrectomy (PPV) with either PRP or inverted ILM flap for the treatment of large MH.


  Methods Top


This prospective study was done at a tertiary care eye hospital in south India from January 2017 to July 2018. Ethical clearance was obtained from the institute's review board (Registration No. ECR/182/Inst/TN/2013 dated 20/04/2013). The study adhered to the tenets of the declaration of Helsinki. All the surgeries were performed by a single vitreoretinal surgeon (NB).

Patients with idiopathic full-thickness macular hole (FTMH) with an MD of 600–1500 μm were included. All the patients were pseudophakic and had not undergone any prior vitreoretinal surgery. Patients with traumatic and myopic MH, MH-associated retinal detachment, axial length < 22 mm or > 24 mm, any coexisting ocular pathologies affecting vision, and patients refusing randomization were excluded. The patients were randomized into two groups with the help of system-generated random number. The size of the MH was not taken into consideration before randomization. The patients underwent 25-gauge PPV with either inverted ILM flap (IFT, group A) or PRP (group B). The nature of the surgery and the associated complications were explained to the patients and written consent was taken.

One week before the surgery, all the patients (both groups) underwent a medical examination by the physician. Their blood samples were tested for sugar levels, human immunodeficiency virus (HIV), and hepatitis B and C. Any patient with positive blood tests or any focus of infection in their body were excluded from the study.

Presenting best-corrected visual acuity (BCVA) was recorded and converted into logarithm of the minimum angle of resolution, that is, logMAR for statistical analysis. Spectral-domain optical coherence tomography (SD-OCT) using high definition 5-line raster scans and 3-dimensional 512×128 macular cube scans passing through the fovea was done and MH parameters were measured.[4]

PRP was prepared inside the operating room (OR). Just before the start of surgery, a 20 mL syringe was filled with 2 mL anticoagulant citrate dextrose solution A (ACD-A, Fresenius Medical Care, Bad Homburg, Germany). The ACDA-filled syringe was then filled with 18 mL of the patient's blood, taken from his anti-cubital vein with the help of a scalp vein. The 20 mL mixture was injected into Dr PRP Kit (Emergo Europe, Netherlands) through the upper part at a moderate speed so that neither the blood clots, due to slow speed, nor the cells get damaged due to rapid transit [Figure 1]a. As the two compartments in the kit are intercommunicating, both compartments get filled.
Figure 1: Preparation of platelet-rich plasma (PRP). (a) 20 mL syringe with a solution of 2 mL anticoagulant citrate dextrose solution A (ACD-A) and 18 mL of blood is injected into the Dr PRP Kit through the upper injection port. The kit has a knob that can be rotated to lock and permanently separate the upper and lower compartments (red arrow). (b) After the first centrifugation, the red blood cells settle in the lower compartment, while the plasma comes to the upper compartment (red arrow)

Click here to view


The tube was placed inside the REMI PRP centrifuge machine (REMI Group, India) for double-centrifugation. The first centrifugation took around 15 min and separated the plasma from red blood cells (RBCs). The RBCs being heavier, settled down in the lower compartment, while the plasma came to the upper compartment [Figure 1]b. The two compartments were then locked by rotating the knob at the bottom of the tube. The tube was centrifuged again for 6 min to achieve platelet concentration. The platelets being heavier settled at the bottom of the upper compartment, while the platelet-poor plasma (PPP) came to the top. The PPP was taken out through the upper part and discarded. PRP was then collected and used within 30 min of preparation.

Patients in both groups underwent 25-gauge PPV. Vitreous was stained with triamcinolone acetate (Aurocort, Aurolab, India) to ensure its complete removal. ILM was stained with 0.05% brilliant blue G dye and peeled in a circular fashion for approximately 2-disc diameters around the hole.

In inverted ILM flap group, margins of the peeled ILM were left attached to the MH edges and trimmed to appropriate size. After performing fluid-air exchange (FAE), the ILM flap was tucked into the hole with diamond-dusted membrane scraper (DDMS; Synergetics, Inc., O'Fallon, MO, USA). Postoperative tamponade was provided with sulfur hexafluoride (SF6) gas with 2 weeks of prone positioning.

In the PRP group, ILM was peeled off. After performing FAE, few drops of PRP was injected directly over the MH, while the rest was sent for platelets count and microbiological examination. Postoperative tamponade was provided with SF6 gas in supine position so as to allow the platelets to settle down on macula.

Postoperative visits were scheduled at day 1, 2 weeks, 1 month, and 3 months. Frequent follow-ups were scheduled, in case of any complication. At each follow-up visit, BCVA, intraocular pressure (IOP), and SD-OCT were recorded. The outcome measures were anatomical and visual outcomes at the end of 3 months. The flattening of the hole with resolution of subretinal cuff of fluid was defined as anatomical closure. The flattening of MH with resolution of subretinal cuff of fluid and neurosensory retina (NSR) completely covering the fovea was termed as type 1 anatomical closure. When the whole rim of the NSR around the MH was attached to the underlying retinal pigment epithelium (RPE) but NSR was absent above the fovea, it was termed as type 2 anatomical closure.[23] When the hole was covered with only the flap without NSR it was called flap-only closure.[24]

Statistics

Statistical analysis was performed with STATA statistical software, Version 14.0 (StataCorp, College Station, Texas, USA). Continuous variables were expressed as mean (± standard deviation). The normality of the data was verified using histogram plot and Shapiro-Wilk test. Independent student's t-test, Mann-Whitney U test, or Wilcoxon sign rank test was used to find out the difference between two continuous variables. Chi-square test and Fisher's exact test were used to find out the difference between two noncontinuous variables. P value less than 0.05 was considered to be statistically significant.


  Results Top


Sixty patients were randomized into two groups of 30 each. The mean age in groups A and B was 59.37 ± 6.71 and 64.33 ± 6.25 years, respectively (P = 0.004). The mean MD in groups A and B was 803.33 ± 120.65 μm and 784.73 ± 120.10 μm, respectively (P = 0.552). The mean base diameter (BD) in groups A and B was 1395.17 ± 240.57 μm and 1486.90 ± 281.61 μm, respectively (P = 0.180). The median presenting BCVA was logMAR 0.78 (range 0.78–1.00) and logMAR 0.78 (range 0.60–1.00) in groups A and B, respectively (P = 0.103) [Table 1].
Table 1: The baseline characteristics of the patients in the two groups

Click here to view


Anatomical closure was achieved in 90% (n = 27/30) and 93.3% (n = 28/30) of eyes in groups A and B, respectively (P = 0.158). Type 1 closure was achieved in 76.7% (n = 23/30) of eyes in group A and 83.3% (n = 25/30) of eyes in group B [Figure 2]. Four eyes (13.3%) in IFT group achieved flap-only closure while three eyes (10.0%) in PRP group achieved type 2 closure. Median BCVA 3-months post-surgery in groups A and B was logMAR 0.60 (range 0.48–0.60) and logMAR 0.60 (range 0.48–0.78), respectively (P = 0.312). The average improvement in BCVA 3-months post-surgery was 2.0 and 2.5 early treatment diabetic retinopathy study (ETDRS) lines in groups A and B, respectively (P = 0.339) [Table 2].
Table 2: Anatomical and functional outcome of patients in both the groups

Click here to view
Figure 2: Ocular coherence tomography images of a patient treated with vitrectomy and platelet-rich plasma. (a) Preoperative configuration of macular hole; (b) 1 month after surgery; and (c) 3 months after surgery

Click here to view


The three holes in the IFT group that failed to close had MD of 1007 μm, 986 μm, and 906 μm. The two holes in PRP group that failed to close had MD of 1201 μm and 939 μm. The four holes in the IFT group that had flap-only closure had MD of 1005 μm, 994 μm, 958 μm, and 896 μm. The three holes in the PRP group that achieved type 2 closure had MD of 772 μm, 786 μm, and 736 μm.

None of the patients in either group developed complications like hypotony, postoperative inflammatory reactions, endophthalmitis, or serous retinal detachment. No case of reopening of the hole was noted till the end of 3 months in either group. Microbiological culture of PRP solution was negative in all the cases.


  Discussion Top


Inverted ILM flap has now become the standard treatment of care for the management of large MHs throughout the world.[9],[10],[11],[12],[13] However, this technique is limited by its steep learning curve and difficulty in maintaining the flap during FAE. Modifications such as the use of viscoelastic cap, perfluorocarbon liquid (PFCL), autologous blood clot, and cabbage-leaf technique have been proposed to prevent flap dislocation.[25],[26],[27],[28],[29],[30],[31]

PRP is increasingly being used as regenerative medicine in other fields of medicine. However, studies evaluating the use of this "healing adjuvant" in MH surgery still remains rudimentary. Not many reports regarding the use of platelets for the treatment of MH exist. Paques et al., in their randomized control trial (RCT), reported that the anatomical success rate for primary MH was significantly greater in the group where platelets were used as an adjunct compared to vitrectomy alone group (98% vs 82%). However, the study being old had two major drawbacks, that is, OCT was not used to measure MH size and ILM peeling was not done.[21] Other studies have reported a primary closure rate of 95–100% with the use of platelets along with ILM peeling.[18],[19],[20],[32] An anatomical closure rate of 78–85% has been reported with the use of autologous platelet concentrate (APC) during re-surgery in case of persistent MH.[22],[33] Coca et al.reported successful anatomical closure of a single chronic traumatic MH with BD of 3000 μm.[34] However, most of the reports are either single-arm non-comparative studies or include small MHs. The efficiency of platelets for large macula holes is limited to mere case reports.

We compared the outcome of 25 G vitrectomy and inverted ILM flap with 25 G vitrectomy and PRP for the treatment of large MHs. Our results showed that the anatomical and visual outcomes of inverted ILM peeling with PRP and inverted ILM flap were similar. As a high concentration of platelets is achieved in PRP, a high concentration of growth factors such as epithelial growth factor, transforming growth factor, and the platelet-derived growth factor is added to the local milieu, which helps drive the regenerative mechanism.[15],[16],[17] Burmeister et al. in theirin vitro studies have demonstrated that autologous platelet concentrate promotes better growth and migration of Muller cell compared to both control and serum. In fact, ILM peeling and platelets may have a synergistic action as ILM peeling stimulates reparative gliosis via muller cells activation, which is enhanced by platelets, too.[35]

Several safety concerns about the use of PRP have been raised. The most important concern is the increased chance of endophthalmitis. However, we did not encounter any case of endophthalmitis or culture growth in any of the PRP samples. The chances of infection were reduced by the use of specialized kits, which prevented exposure of contents to environment at any point in time. Also, PRP has been shown to have antimicrobial activity against  Escherichia More Details coli, Staphylococcus aureus, Candida albicans, and Cryptococcus neoformans.[17] The second concern is the presumed increased risk of inflammatory reaction to PRP. Gamulescu et al.reported a case of exudative retinal detachment after using APC for the treatment of MH.[36] However, none of the patients in our study developed out of proportion inflammation.

The benefits of other blood-based derivatives in MH surgery have also been studied earlier.[37],[38] Banker et al. reported that serum may have a possible benefit in larger holes.[38] Ghosh et al.reported earlier and better visual rehabilitation with the use of whole blood. They attributed this to earlier photoreceptor regeneration and was confirmed by inner segment/outer segment junction continuity and increase in outer foveal thickness on OCT.[39],[40] On the contrary, Purtskhvanidze et al.reported that while APC was effective in the treatment of persistent MH, autologous whole blood did not (85.2% vs 7.1%).[41]

To the best of our knowledge, this was the first prospective study comparing the efficacy of 25 G PPV and PRP with 25 G PPV and inverted ILM flap for treatment of large MH. In our pilot study, we found that the use of platelets for the treatment of large MH was not only safe but also equally effective to inverted ILM flap. With the availability of specific kits, PRP can now be prepared easily and safely in the OR itself. However, the patients should be screened carefully for a systemic disease like HIV, Hepatitis B and C, and with any other foci of infection. Although there is no data suggesting that the use of PRP for treatment of FTMH is contraindicated in such patients, it is better avoided. The possible increased risk of endophthalmitis and inflammation makes them less attractive for practicing ophthalmologists. Also, the additional cost burden and technical challenges associated with its preparation make it difficult to be copied on wide scale. Inverted ILM flap technique remains the preferred technique in such cases.


  Conclusion Top


This study was limited by its small sample size and short duration of follow-up. As the ease of obtaining whole blood makes its use more repeatable in clinical practice, adding a third arm with whole blood will not be out of place. Although initial studies show that blood-based derivatives are safe and effective, it is necessary to carry out randomized clinical trials to evaluate the potential of whole blood as well as autologous platelets in MH surgery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wakely L, Rahman R, Stephenson J. A comparison of several methods of macular hole measurement using optical coherence tomography, and their value in predicting anatomical and visual outcomes. Br J Ophthalmol 2012;96:1003-7.  Back to cited text no. 1
    
2.
Chhablani J, Khodani M, Hussein A, Bondalapati S, Rao HB, Narayanan R, et al. Role of macular hole angle in macular hole closure. Br J Ophthalmol 2015;99:1634-8.  Back to cited text no. 2
    
3.
Kumagai K, Furukawa M, Ogino N, Uemura A, Demizu S, Larson E. Vitreous surgery with and without internal limiting membrane peeling for macular hole repair. Retina 2004;24:721-7.  Back to cited text no. 3
    
4.
Ullrich S, Haritoglou C, Gass C, Schaumberger M, Ulbig MW, Kampik A. Macular hole size as a prognostic factor in macular hole surgery. Br J Ophthalmol 2002;86:390-3.  Back to cited text no. 4
    
5.
Wong R. Novel surgical technique for closure of large full-thickness macular holes. Retina 2013;33:1977-9.  Back to cited text no. 5
    
6.
Felfeli T, Mandelcorn ED. Macular hole hydrodissection: Surgical technique for the treatment of persistent, chronic, and large macular holes. Retina 2019;39:743-52.  Back to cited text no. 6
    
7.
Charles S, Randolph JC, Neekhra A, Salisbury CD, Littlejohn N, Calzada JI, et al. Arcuate retinotomy for the repair of large macular holes. Ophthalmic Surg Lasers Imaging Retina 2013;44:69-72.  Back to cited text no. 7
    
8.
Yepez JB, Murati FA, De Yepez J, Petitto M, Arevalo JF. Anterior lens capsule in the management of chronic full-thickness macular hole. Retin Cases Brief Rep 2018;12:286-90.  Back to cited text no. 8
    
9.
Michalewska Z, Michalewski J, Adelman RA, Nawrocki J. Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology 2010;117:2018-25.  Back to cited text no. 9
    
10.
Yamashita T, Sakamoto T, Terasaki H, Iwasaki M, Ogushi Y, Okamoto F, et al. Best surgical technique and outcomes for large macular holes: Retrospective multicentre study in Japan. Acta Ophthalmol 2018;96:e904-10  Back to cited text no. 10
    
11.
Gu C, Qiu Q. Inverted internal limiting membrane flap technique for large macular holes: A systematic review and single-arm meta-analysis. Graefes Arch Clin Exp Ophthalmol 2018;256:1041-9.  Back to cited text no. 11
    
12.
Manasa S, Kakkar P, Kumar A, Chandra P, Kumar V, Ravani R. Comparative evaluation of standard ILM peel with inverted ILM flap technique in large macular holes: A prospective, randomized study. Ophthalmic Surg Lasers Imaging Retina 2018;49:236-40.  Back to cited text no. 12
    
13.
Rizzo S, Tartaro R, Barca F, Caporossi T, Bacherini D, Giansanti F. Internal limiting membrane peeling versus inverted flap technique for treatment of full-thickness macular holes: A comparative study in a large series of patients. Retina 2018;38 (Suppl 1):S73-8.  Back to cited text no. 13
    
14.
Mao AS, Mooney DJ. Regenerative medicine: Current therapies and future directions. Proc Natl Acad Sci USA 2015;112:14452-9.  Back to cited text no. 14
    
15.
Annunziata M, Guida L, Nastri L, Piccirillo A, Sommese L, Napoli C. The role of autologous platelet concentrates in alveolar socket preservation: A systematic review. Transfus Med Hemother 2018;45:195-203.  Back to cited text no. 15
    
16.
Suthar M, Gupta S, Bukhari S, Ponemone V. Treatment of chronic non-healing ulcers using autologous platelet rich plasma: A case series. J Biomed Sci 2017;24:16.  Back to cited text no. 16
    
17.
Lacci KM, Dardik A. Platelet-rich plasma: Support for its use in wound healing. Yale J Biol Med 2010;83:1-9.  Back to cited text no. 17
    
18.
Wachtlin J, Jandeck C, Potthöfer S, Kellner U, Foerster MH. Long-term results following pars plana vitrectomy with platelet concentrate in pediatric patients with traumatic macular hole. Am J Ophthalmol 2003;136:197-9.  Back to cited text no. 18
    
19.
Konstantinidis A, Hero M, Nanos P, Panos GD. Efficacy of autologous platelets in macular hole surgery. Clin Ophthalmol 2013;7:745-50.  Back to cited text no. 19
    
20.
Kapoor KG, Khan AN, Tieu BC, Khurshid GS. Revisiting autologous platelets as an adjuvant in macular hole repair: Chronic macular holes without prone positioning. Ophthalmic Surg Lasers Imaging 2012;43:291-5.  Back to cited text no. 20
    
21.
Paques M, Chastang C, Mathis A, Sahel J, Massin P, Dosquet C, et al. Effect of autologous platelet concentrate in surgery for idiopathic macular hole: Results of a multicenter, double-masked, randomized trial. Platelets in Macular Hole Surgery Group. Ophthalmology 1999;106:932-8.  Back to cited text no. 21
    
22.
Purtskhvanidze K, Frühsorger B, Bartsch S, Hedderich J, Roider J, Treumer F. Persistent full-thickness idiopathic macular hole: Anatomical and functional outcome of revitrectomy with autologous platelet concentrate or autologous whole blood. Ophthalmologica 2018;239:19-26.  Back to cited text no. 22
    
23.
Landolfi M, Zarbin MA, Bhagat N. Macular holes. Ophthalmol Clin North Am 2002;15:565-72.  Back to cited text no. 23
    
24.
Michalewska Z, Michalewski J, Dulczewska-Cichecka K, Adelman RA, Nawrocki J. Temporal inverted internal limiting membrane flap technique versus classic inverted internal limiting membrane flap technique: A comparative Study. Retina 2015;35:1844-50.  Back to cited text no. 24
    
25.
Andrew N, Chan WO, Tan M, Ebneter A, Gilhotra JS. Modification of the inverted internal limiting membrane flap technique for the treatment of chronic and large macular holes. Retina 2016;36:834-7.  Back to cited text no. 25
    
26.
Park SW, Pak KY, Park KH, Kim KH, Byon IS, Lee JE, et al. Perfluoro-n-octane assisted free internal limiting membrane flap technique for recurrent macular hole. Retina 2015;35:2652-6.  Back to cited text no. 26
    
27.
Aurora A, Seth A, Sanduja N. Cabbage leaf inverted flap ILM peeling for macular hole: A novel technique. Ophthalmic Surg Lasers Imaging Retina 2017;48:830-2.  Back to cited text no. 27
    
28.
Shin MK, Park KH, Park SW, Byon IS, Lee JE. Perfluoro-n-octane-assisted single-layered inverted internal limiting membrane flap technique for macular hole surgery. Retina 2014;34:1905-10.  Back to cited text no. 28
    
29.
Lai CC, Chen YP, Wang NK, Chuang LH, Liu L, Chen KJ, et al. Vitrectomy with internal limiting membrane repositioning and autologous blood for macular hole retinal detachment in highly myopic eyes. Ophthalmology 2015;122:1889-98.  Back to cited text no. 29
    
30.
Chakrabarti M, Benjamin P, Chakrabarti K, Chakrabarti A. Closing macular holes with "macular plug" without gas tamponade and postoperative posturing. Retina 2017;37:451-9.  Back to cited text no. 30
    
31.
Finn AP, Chen X, Viehland C, Izatt JA, Toth CA, Vajzovic L. Combined internal limiting membrane flap and autologous plasma concentrate to close a large traumatic macular hole in a pediatric patient. Retin Cases Brief Rep 2018. doi: 10.1097/ICB.0000000000000762. [Epub ahead of print].  Back to cited text no. 31
    
32.
Vote BJ, Membrey WL, Casswell AG. Autologous platelets for macular hole surgery: The Sussex eye hospital experience. Clin Exp Ophthalmol 2004;32:472-7.  Back to cited text no. 32
    
33.
Dimopoulos S, William A, Voykov B, Ziemssen F, Bartz-Schmidt KU, Spitzer MS. Anatomical and visual outcomes of autologous thrombocyte serum concentrate in the treatment of persistent full-thickness idiopathic macular hole after ILM peeling with brilliant blue G and membrane blue dual. Acta Ophthalmol 2017;95:e429-30.  Back to cited text no. 33
    
34.
Coca M, Makkouk F, Picciani R, Godley B, Elkeeb A. Chronic traumatic giant macular hole repair with autologous platelets. Cureus 2017;9:e955.  Back to cited text no. 34
    
35.
Burmeister SL, Hartwig D, Limb GA, Kremling C, Hoerauf H, Müller M, et al. Effect of various platelet preparations on retinal Muller cells. Invest Ophthalmol Vis Sci 2009;50:4881-6.  Back to cited text no. 35
    
36.
Gamulescu MA, Roider J, Gabel VP. Exudative retinal detachment in macular hole surgery using platelet concentrates-A case report. Graefes Arch Clin Exp Ophthalmol 2001;239:227-9.  Back to cited text no. 36
    
37.
Liggett PE, Skolik DS, Horio B, Saito Y, Alfaro V, Mieler W. Human autologous serum for the treatment of full-thickness macular holes. A preliminary study. Ophthalmology 1995;102:1071-6.  Back to cited text no. 37
    
38.
Banker AS, Freeman WR, Azen SP, Lai MY. A multicentered clinical study of serum as adjuvant therapy for surgical treatment of macular holes. Vitrectomy for macular hole study group. Arch Ophthalmol 1999;117:1499-502.  Back to cited text no. 38
    
39.
Ghosh B, Arora S, Goel N, Seth A, Pyare R, Sridharan P, et al. Comparative evaluation of sequential intraoperative use of whole blood followed by brilliant blue versus conventional brilliant blue staining of internal limiting membrane in macular hole surgery. Retina 2016;36:1463-8.  Back to cited text no. 39
    
40.
Arora S, Goel N, Arora T, Sharma P, Raina UK, Thakar M, et al. Comparative evaluation of retinal nerve fiber layer thickness after conventional brilliant blue assisted internal limiting membrane peeling versus brilliant blue selective staining using whole blood in macular hole surgery. Ophthalmic Surg Lasers Imaging Retina 2016;47:436-42.  Back to cited text no. 40
    
41.
Purtskhvanidze K, Frühsorger B, Bartsch S, Hedderich J, Roider J, Treumer F. Persistent full-thickness idiopathic macular hole: Anatomical and functional outcome of revitrectomy with autologous platelet concentrate or autologous whole blood. Ophthalmologica 2018;239:19-26.  Back to cited text no. 41
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
    Similar in PUBMED
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Methods
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed271    
    Printed0    
    Emailed0    
    PDF Downloaded60    
    Comments [Add]    

Recommend this journal