Outcome of autologous platelet concentrate and gas tamponade compared to heavy silicone oil tamponade in persistent macular hole surgery

摘要

Purpose: Persistence represents the major reason for failure of primary macular hole repair. A variety of surgical approaches are available for treating persistent macular holes. To compare clinical outcome of re-pars plana vitrectomy combined with autologous platelet concentrate and sulfur hexafluoride 20 gas tamponade with heavy silicone oil in persistent macular hole. Methods: Records of 48 consecutive eyes with persistent macular holes which underwent re-pars plana vitrectomy with either heavy silicone oil (35 eyes, persistent macular–hole minimum linear diameter: 518.8?±?171.1?μm) or autologous platelet concentrate and sulfur hexafluoride 20 (13 eyes, persistent macular hole–minimum linear diameter: 454.1?±?211.3?μm) were reviewed retrospectively. All patients underwent measurements of anatomical persistent macular hole characteristics evaluated by optical coherence tomography and visual function. Cases in which anatomical success failed after first re-pars plana vitrectomy were treated with the other surgical techniques, comparable to a cross-over design. Results: Persistent macular hole closure rate was 57.1 with autologous platelet concentrate and sulfur hexafluoride 20 and 45.7 with heavy silicone oil ( p ?=?0.102). Functional results were comparable when persistent macular hole closure was achieved ( p ???0.741), but significantly better for the autologous platelet concentrate with sulfur hexafluoride 20 group when persistent macular hole closure failed ( p ?=?0.019). Conclusion: Re-pars plana vitrectomy combined with autologous platelet concentrate and sulfur hexafluoride 20 seems to achieve at least non-inferior persistent macular hole closure rates and comparable functional results when compared to heavy silicone oil, suggesting autologous platelet concentrate and sulfur hexafluoride 20 as a safe surgical alternative in persistent macular hole. Especially when persistent macular hole closure failed, autologous platelet concentrate with sulfur hexafluoride 20 seems to be superior regarding visual outcome.